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� v <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNTY <br /> Telephone: (209) 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 AND/OR FACILITY <br /> LOCATED AT 1909 Cemetary Lane Stockton, CA <br /> (Street Address) (City) <br /> HEREBY <br /> AUTHORIZE Cal Tech Environmental Laboratories of Paramount, California <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 SAME <br /> TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: St. Joseph's Medical Center <br /> (If Applicable) <br /> OWNER/OPERATOR: John Stagg Assistant Chief Engineer- Plant Maintenance/ Plant Operations <br /> (Please Print) (Title) <br /> i <br /> (Owner/0for azure) ( ate) <br /> ADDRESS: 1909 Cemetary Lane <br /> (Mailing Address) <br /> Stockton CA 95204 <br /> (City) (State) (Zip Code) <br /> PHONE:( 209 461-6818 <br /> EH 23 046 (Revised 8/1/11) 8 <br />