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SAN JOAQUIN COUNTY PUBLIC HEALTH SERV ICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209) 468-3420 <br /> ALTHORIZATIOti TO RELEASE <br /> * ANALYTICAL RESULTS <br /> * GEOTECHNICAL DATA <br /> * ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED Q_WNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 530 E. Market St . , Stockton, CA 95202 <br /> (Street Address) (Ciry) <br /> HEREBY AUTHORIZE GeoAnalytical Laboratories <br /> (Laboratory) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> HEALTH SERVICES-ENVIRONMENTAL HEALTH DIVISION AS SOON AS IT IS AVAILABLE AND AT THE S.-k�1E <br /> TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: __T7t-12_ �{ �KTz`:,� A16?•UsPA��'1ZS Trtc. <br /> (IfApplicable) <br /> TK�i ay�� <br /> OWNER/OPERATOR: �h ✓2� (Title) <br /> (Please nt) <br /> (Own /Operator Si,,nature) (Date) <br /> ADDRESS: S 3 D 4e57 <br /> (Mailing Address) <br /> S-rz3c. *-ra A) C — <br /> (City) (State) (Zip Code) <br /> PHONE: (_,20? ) <br /> EH 23 046 (Revised 08/13/99) Page 9 <br />