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E <br />11 <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />(209) 468-3420 <br />Iffelti-r—A&MM 00341y", <br />0 ANALYTICAL RESULTS <br />* GEOTECHNICAL DATA <br />0 ENVIRONMENTA141SITE ASSESSMENT INFORMATION <br />LOCATED AT 3300 N. West Lane, Stockton, CA <br />(Street Address) (city) <br />HEREBY AUTHORIZE GeoAnalvtical Laboratories <br />(Laboratory or Conniftma) <br />TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br />HEALTH SERVICES AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED <br />TO ME OR MY REPRESENTATIVE. <br />BUSINESS NAME: <br />DATE: <br />Applicable) <br />(Pleasee'Print) (Title) <br />ADDRESS: <br />(Mailing Address) <br />(C4) (State) (Zip Code) <br />PHONE:( -209' ) e70 7 <br />EH 23 041 (Revised 7-10-92) Page 9 <br />