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�r v <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />(709) 468-3420 <br />AUTHORIZATION TO RELEASE <br />• ANALYTICAL RESULTS <br />' GEOTECHNICAL DATA <br />• ENVIRONMENTAUSITE ASSESSMENT INFORMATION <br />1, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br />LOCATED AT <br />446 N. Aurora Street, Stockton, CA <br />(City) <br />HEREBY AUTHORIZE Vc <br />/ (Laboratory or Conwftant) <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 />O WNERIOPERATOR: <br />ADDRESS: ' 7W!o %' /. <br />(Mailing Address) <br />(City) <br />PHONE: (9!11� I <br />DATE: <br />EH 23 041 (Revised 7-10-92) Page 9 <br />(State) <br />Code) <br />