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SN N 1 U N W N Environmental Health Department <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 LOCATED AT <br /> 619 and 625 North Sacremento Street Lodi, 95242 <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE <br /> Envrio-Chem Inc. <br /> (Laboratory) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT AS SOON AS IT IS AVAILABLE AND AT THE <br /> SAME TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE , <br /> BUSINESS NAME : DBL Rentals <br /> (OrApplicable) <br /> I <br /> OWNER/OPERATOR _ John Bubica <br /> (Please Print) (Title) <br /> < SIGMHfRF <br /> (Ownter/Operator Signature)) (Da ) <br /> ADDRESS: 701 South Ham Lane, Suite C <br /> (Mailing Address) <br /> Lodi CA 95242 <br /> (City) (State) (Zip Code) <br /> PHONE: 20( 9 ) 625 -5261 <br /> 8of10 <br />