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SAN JOAQUIN COUNTY PUMLIC I:Ek= SE.RVICE.S <br /> ENVIRONMENTAL HE TH DIVISION <br /> (?09) -68-34 0 <br /> AUTHORIZATION TO RELEASE <br /> .kNALYTiCAI SULTS <br /> x <br /> GEOTEC'z-MICAL DATA <br /> ENNUZON-MENTALLSi i i INFORMATION <br /> I, THE UNDERSIGNED OWNER A DIOR OPERATOR OF 7.-.-E PROPERTY A-N- DIOR FACILITY <br /> 345 Yosemite Avenue Stockton <br /> LOCATED AT <br /> fc, <br /> I�1reC�ep'01 l Analytical. <br /> ry) <br /> :HEREBY AU T HOPUZE <br /> (L2oorctor,) <br /> TO RELEASE. ANY AuND ALL AIN �LYTICAL iI1[FORV1Ai:ON T SA-N IOAQUTN COUNTY PUBLIC <br /> HEALTH SERVICES-EWaONMENTAL HEALTH DIVISICN A SCCON AS IT IS AVAILABLE %.ND AT THE S,'.-AH <br /> TME 1T iS PROV'TDED TO ME OR MY REPRESENT-17Vz-. <br /> Advanced GeoEnvironmental Inc. <br /> S t rrrre—=� posi-t--B-ank <br /> BUSINESS NAME: <br /> (Ij 1Lpiic�iej _ ` <br /> T-2• ) �j � �F2�SCh.S L D����',3 ��i�� � <br /> 0W:`IERi0PER.-k T OR: <br /> (PI2n.S2 (—Zi r I e)� <br /> { 1ZO <br /> r Si"1 re) K �� G�Ah� (Dare) <br /> ADDRESS: O Box 1 <br /> (Mcii:ng address) <br /> Stockton, Ca 95202 <br /> (City) (Sure) (Zp Cade) <br /> PHONE: ( 209 946-5050 <br /> EH 23 046 (Revised 7110,'96) Page 9 <br />