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PUBLI <br /> HEALTH SERr4CES <br /> SAN JOAQUIN COUNTY �< <br /> JOGI KIIANNA M.D.,M.P.11. ;• <br /> Health Officer <br /> P,O. Box 2009 • (1601 East 1lavelton Avenue) • Stockton,California 95201 <br /> (209) 468.3400 <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209) 468-3427 <br /> AU'TI IORILA TION 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 2150 E. Fremont Street, Stockton , CA (City) <br /> (Street Address) <br /> HERESY AUTHORIZE c-� <br /> (Laboratory or Consultant) <br /> 7-0 RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> 7 <br /> I IEALTI I SERVICES AS SOON AS ITIS AVAILABLE AND AT TME SAME TIME IT IS PROVIDED <br /> TO ME OR MY REPRESEN'T'A'T'IVE. <br /> BUSINESS NAME: <br /> �((IfApppp�licable) <br /> OWNER/OPERATOR: (Title) <br /> (Pn e Print) <br /> (Sign ure <br /> ADDRE14;Q <br /> (Mailing Address) <br /> (City) <br /> (State) (zip code) <br /> PHONE: Lziuf—) <br /> DATE: <br /> Ell 23 041 (REV 2/8/91) wP <br /> Page 9 <br /> A nlvleton of San Jo2win Cnonty ltcatth Cite Scrrtces � <br />