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ENVIRONMENTAL HEALTH DIVISION <br />(209) 468-3420 <br />AUTHORIZATION TO RELEASE <br />' ANALYTICAL RESULTS <br />' GEOTECHNICAL DATA <br />' ENVIRONMENTAUSITE ASSESSMENT INFORMATION <br />I. THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br />LOCATED AT 25600 ChrL <br />(Sara Ad&=) <br />HEREBY AUTHORIZE <br />s <br />(Laboratory or Conra(tartr) <br />TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br />HEALTH SERVICES AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED <br />TO ME OR MY REPRESENTATIVE <br />BUSINESS NAME- <br />OWNER/OPERATOR. <br />AME <br />(If <br />OWNEt/OPERATOR: <br />ADDRESS: 25600 Chrisman Road <br />(MaduBAddrw) <br />Tracy California 95376 <br />(cry) (State) (zip code) <br />PHONE ( 209 832-9908 <br />DATE: <br />PAGE 9 <br />dAC�ca <br />