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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209) 468-33420 <br /> AUTHORIZATION TO RELEASE <br /> * ANALYTICAL RESULTS <br /> * GEOTECHNICAL DATA <br /> * ENVIRON✓[ENTAL/SITE ASSESSbIENT INFORMATION <br /> I, THE UNDERSLG`.EJZQWNNZ�_ gND:OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 767 N. Alpine Rd. Slgckton , CA 9,991 R <br /> (Street Address) (City) <br /> HEREBYAUTHORIZE G eoAnalytical Laboratories <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: Tony Jockovich Trust , c/o Marie Lopez Trustee <br /> (If Applicable) <br /> 0 W NER/OPERATOR: <br /> Same as above <br /> (Please Print) (Title) <br /> (Owner/Operator Sig ure) (Date) <br /> ADDRESS: 8567 O1ford Rd. <br /> (Alailing Address) <br /> Stockton, CA 95215 <br /> (City) (State) (Zip Cade) <br /> PHONE: ( 209 ) 948-2482 <br /> EH 23 046 (Revised 08/li/99) Page 9 <br />