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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DMSION <br /> (209)468-3420 <br /> AUTHORIZATION TO RELEASE <br /> * ANALYTICAL RESULTS <br /> * GEOTECHNICAL DATA <br /> * ENVIRONMENTAL/SrrE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER ANDiOR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 8709 N. Davis Rd. , Stockton CA 95209 <br /> (Street Address) (city) <br /> HEREBYAUTHORIZE GeoAnalvtical 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: North Stockton Auto Service <br /> (If Applicable) <br /> OWNER/OPERATOR: Ed Niemann Own <br /> er <br /> Please Print) (Title) <br /> (Owner/OperatorSignature) (Date) <br /> ADDRESS: 8709 N. D via Rd- <br /> (Mailing Address) <br /> Stockton, CA 95209 <br /> (city) (state) (Zip Code) <br /> PHONE: ( 2(]9 ) 478_ 674 <br /> EH 23 046 (Revised 10/19/98) Page 9 <br />