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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 />1, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br />LOCATED AT 47 East Eleventh Street Tracy, CA <br />(Street Address) (City") <br />HEREBY <br />AUTHORIZE Precision Enviro-Tech, Stockton, California <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: Levand Family Trust Property <br />(JfAPplicable) -- - - — — <br />OWNER/OPERATOR: ___ c/o Paula Levand Trustee <br />(Ple e Print) (I itle) <br />rvwner/Uperator Signature) (Date) <br />ADDRESS: 24692 Sand Wedge Lane <br />(Mat/ing Address) <br />Valencia CA 91355 <br />(City) (State) (Zip Code) <br />PHONE:6( 61 ) 904-2133 <br />EH 23 046 (Revised 8/I/1 1) <br />8 <br />