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ENVIRONMENTAL HEALTH DEPARTMENT <br /> SAN JOAQUINC OUNTY <br /> Telephone: (2 09)468-3420 Fax: (209)468-3433 <br /> AUTHORIZATION TO RELEASE <br /> ANALYTICAL RESULTS <br /> GEOTECHNICAL DATA <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I,THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY /OR FACILITY <br /> LOCATED AT <br /> 500 W. Hospital Ra*p, French Camp <br /> (StreetAddress) (city,} <br /> HEREBY AUTHORIZE <br /> Advanced Geo Environmental, Inc./ Cal-Tech Environmental Laboratories <br /> (Laboratoty) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TOS JOAQUIN COUNTY ENVIRONMENTAL HEALTH <br /> DEPARTMENT AS SOON AS IT IS AVAILABLE AND AT THE SAME <br /> TIME IT IS PROVIDED TO 1%4E OR MY REPRESENTATIVE- <br /> Joseph Bagley <br /> BUSINESS NAME: Bagley Enterprises, Inc. <br /> (If Applicable) <br /> OWNER: <br /> Joseph Bagley Contractor for San Joaquin General Hospital <br /> (PL-ase Print) (Title) <br /> (#Wn-ff-8ignawre) (Date) <br /> ADDRESS: 2 �OMaggio Circle, Unit 4 <br /> (MailingAd&ess) <br /> Lodi CA 95240 <br /> PN) (State) (Zip Code) <br /> PHONE:(209 367-4800 <br /> EH 23 046 (Revised 02/20/09) <br /> 5 <br />