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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 j&470 Cambridge Avanv La+hrop <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE c'G!jyo(D Amal)di6al Labs <br /> (laboratory) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> HEALTH SERVICES-ENVIRONMENTAL HEALTH DIVISION AS SOON AS IT IS AVAILABLE AND AT THE SAME <br /> TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: 6ItoIB K 1:;ac.i1i4X WIZ05 (Tosco Mktg, 60-) <br /> (If Applicable) <br /> OWNER/OPERATOR: Aaog 671anl%70 AYr71 Tor 7054o /-fark-,t'. 60 <br /> (Please Print) (Title) <br /> _/Town*Operator Signature) (Date) <br /> ADDRESS: /390 /A/.'//pt✓ /27ss 'ed SUi7d 420 <br /> (Mailing Address) <br /> G0n410125( 6.4 945 ZO <br /> (City) (State) (Zip Code) <br /> PHONE: ( 510 > 6o09 -6300 <br /> EH 23 046 (Revised 9/11/96) Page 9 <br />