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SAN%.,AQUIN COUNTY PUBLIC HEALTH SER,,.ES <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 <br />i <br />I, 1 H UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br />LOCATED AT Henry Hansen Property 200 S. Cherokee Lane, Lodi, CA 95240 i <br />(Street Address) (city) <br />HEREBY AUTHORIZE GeoAnalytical Laboratories <br />(Laboratory) <br />'IO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br />HF,ALIIt SERVICES -ENVIRONMENTAL HEALTH DIVISION AS SOON AS IT IS AVAILABLE AND AT THE SAME <br />I IN1E Il' IS PROVIDED TO ME OR MY REPRESENTATIVE. <br />BUSINESS NAME: Henry Hansen Property <br />(LJ Applicable) <br />OWNER/OPFRATOR: Henry Hansen c/o Right Way ,Inc. <br />ADDRESS: <br />(Please Print) <br />(Tile) <br />Address) <br />Lodi, CA 95240 <br />(city) (state) (Zip code) <br />PHONE:( 209 ) 369-7335 <br />EH 23 046 (Revised 9/11/96) Page 9 <br />