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ENVIRONMENTAL HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNTY <br /> Telephone: (209)468-3420 Fax: (209) 468-3433 <br /> AUTHORIZATION TO RELEASE <br /> *ANALYTICAL RESULTS <br /> *GEOTECHNICAL DATA <br /> * ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I,THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 1331 S. Ham Lane Lodi CA 95242 <br /> (Street Address) (City) <br /> HEREBY Geoanalytical Laboratories <br /> AUTHORIZE_ _ <br /> (Laboratory) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT AS SOON AS IT IS AVAILABLE AND AT THE SAME <br /> TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: City of Lodi <br /> (If Applicable) <br /> OWNER/OPERATOR: Kathryn E. Garcia Compliance Engineer <br /> Pl ase Print)) y� (Title) <br /> pwnei&6perator S' ature) (Date) <br /> ADDRESS: 1331 S. Ham Lane <br /> (Mailing Address) <br /> Lodi CA 95241 <br /> (City) (State) (Zip Code) <br /> PHONE:( 209 333-6740 <br /> EH 23 046 (Revised 07/22/10) 8 <br />