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SAN JeQUIN COUNTY PUBLIC HEALTH SERVIfES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209) 468-3420 <br /> AUTHORIZATION TO RELEASE <br /> • ANALYTICAL RESULTS <br /> • GEOTECHNICAL DATA <br /> • ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 1209 W. Fremont Street Stockton, CA 95203 <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE GeoAnalytical Laboratories <br /> (Laboratory or Consultant) <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 TO <br /> ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME :Pelar W^ter We <br /> (IjApplicable) <br /> OWNER/OPERATOR : Bdrrt Milnalavich tk^.a <br /> se Print) ' ,A�' le) <br /> (Owner/Operator Signature) <br /> ADDRESS: 1029 W Fremnnt St <br /> (Mailing Address) <br /> ,tocw0o, 955203 <br /> (City) (State) (Zip) <br /> PHONE: (209)466-6766 <br /> DATE: <br /> Page 9 <br /> EH 23 041 (Remsed 7-10-92) <br />