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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209) 468-3420 <br /> AUTHORIZATION TO RELEASE <br /> * ANALYTICAL RESULTS <br /> * GEOTECHNICAL DATA <br /> " ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> l�jr-rk-Tw' <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 4707 la-JGI{IG /avenuel Stockton <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE Sequoia Anol tcal Labs <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 SAME <br /> TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: TOxe F2e—i14Y # ZS(oqSl 7(0 <br /> (If Applicable) <br /> Aqerd To- <br /> OWNER/OPERATOR: KIAL pesio�n (�rouR, InG. CZaiga (viaFroj. 60on inator <br /> (P_lease Print) (Title) <br /> ( ner/Operator Signature) (Date) <br /> ADDRESS: 154-62 Armol i p6,1e Saito In <br /> (Mailing Address) <br /> Hortind'a GA �45`J3 <br /> (City) (State) (Zip Code) <br /> PHONE: ( IZ.1.J ) 31�v- 8700 <br /> EH 23 046 (Revised 10/19/98) Page 9 <br />