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E <br />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 />I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br />LOCATED AT 3032 E. Waterloo Rd. Stockton <br />HEREBY AUTHORIZE (Street Address) (City) <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: Waterloo Food & Fuel <br />(If Applicable) <br />OWNER/OPERATOR: <br />Keith -A. Tallia <br />Aaent <br />ADDRESS: 3032 E. Waterloo Rd. <br />(Mailing Address) <br />Stockton <br />(City) <br />PHONE: ( 209 ) 466-5816 <br />DATE: 9/27/99 <br />EH 23 041 (Revised 7-10-92) Page 9 <br />CA 95205 <br />(State) (Zip Code) <br />