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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 />' ENVIRONMENTAUSITE ASSESSMENT INFORMATION <br />I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br />LOCATED AT 3425 Tracy Blvd Tracy, CA <br />(Street Address) (City) <br />HEREBY AUTHORIZE TD.IT * <br />(Laboratory or Consultant) <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: ANASTASIO' S AM/PM MINI MART <br />(If Applicable) <br />OWNER/OPERATOR: Atlantic Ricbgl4ld Company Attn: Cora Cabrea <br />(Please ) (Title) <br />(Owner/Operator <br />ADDRESS: 17315 Studebaker Road <br />(Mailing Address) <br />Cerritos CA 90701-1488 <br />(City) (State) (Zip Code) <br />PHONE: 2( 13 ) 404-5335 <br />DATE.- <br />EH <br />ATE: <br />EH 23 041 (Revised 7-10-92) Page 9 <br />