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SANSeAQU1N COUNTY PUBLIC HEALTH SERVIdS <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209)468-)420 <br /> AUTHORIZATION 'I'O RELEASE <br /> • ANALYTICAL RESULTS <br /> " GEOTECIINICAL DATA <br /> • ENVIRONMENTAUSII'E ASSESSMENT INFORMATION <br /> I, 11111 UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 3147 S. E1 Dorado St . , Stockton, CA 95206 <br /> (Street Address) (City) <br /> IIFRFBY AU'IIIORItE GeoAnalvtical Laboratories <br /> (Inharataq) <br /> '10 RFLFASE ANY AND ALL ANALY'T'ICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> IIFAI,IIf SERVICES-ENVIRONMENTAL IIEALTII DIVISION AS SOON AS IT IS AVAILABLE AND AT THE SAME <br /> 'I IMF I'i' IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: Van De Pol Enterprises <br /> (IJ Applicable) <br /> OWNFR/OPERATOR: Van De Pol Enterprises/ Owner <br /> (Please Print) (pile) <br /> (Dsrner/Operelar Signature) (bale) <br /> ADDRESS: P.O. Box 1107 <br /> (Afaillag Address) <br /> Stockton, CA 95201 <br /> (City) (State) (LIP Cede) <br /> PHONE: ( 209 ) 466-5921 <br /> EII 23 046 (Revised 9/11/96) Page 9 <br />