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i <br /> SAID ZUIN COUNTY PUBLIC HEALTH SER' ; <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209) 468-3420 i <br /> AUTHORIZATION HORIZATION TO RELEASE <br /> i <br /> i <br /> • ANALYTICAL RESULTS <br /> • GEOTECHNICAL DATA <br /> • ENVIRONMENTAUSITE ASSESSMENT INFORMATION ' <br /> — I <br /> i <br /> 1, TILE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY ' <br /> I.,UCATED AT 3230 N. West -Lane , Stockton , CA 95204 <br /> i <br /> (Street Address) (City) <br /> I1FRF13Y AU"ItIUR17_E GeoAnalytical Laboratories <br /> {Lahatntary) <br /> 10 RF-LFASF ANY AND ALL ANALYTICAL INFORMATION TU SAN JOAQUIN COUNTY PUBLIC <br /> 11FALI H SERVICES-ENVIRONMENTAL HEALTH DIVISION AS SOON AS IT IS AVAILABLE AND AT THE SAME <br /> 1 ihlF IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> nUSINESS NAME: Van De Pol Enterprises <br /> (If Applicable) <br /> owNFR/UP>rRATOR: Van De Pol Enterprises, Owner <br /> (Please Print) Mule) <br /> c <br /> 9/15/98 <br /> (Uwner/Operator Signature) ` (Date) <br /> ADDRESS: p-p B3ox 1107 <br /> (Afailing Address) <br /> Stockton, CA 95201-1107 <br /> -- <br /> (City) (5117te) (Ll p Code) <br /> PIIUNE: ( 20cL_) 921 <br /> :N 2J 046 (Revised 9/11/96) Page 9 <br />