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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209) 468-3420 <br /> AUTHORIZATION TO RELEASE <br /> w ANALYTICAL RESULTS <br /> * GEOTECHNICAL DATA <br /> ENVIRONMENTALISITE ASSESSMENT INFORMATION <br /> I, THE UNDERSLG`�EIZG__?N'ER,AN 'OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 541 E. Harding Way, Stockton, CA 95203 <br /> (Street Address) City) <br /> HEREBY AUTHORIZE GeoAnalytical Laboratories <br /> (Laboratory) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUINCOUNTY 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 /> a-;,vne 5H N 9f <br /> (If Applicable) <br /> (Please Print) <br /> ner- for Si;na <br /> L4 ld&er-e b <br /> It <br /> nt'dddress).. <br /> j s 3 O 7 <br /> !Zip <br /> EH 23 046 (Revised 08/13/99) Pa=e 9 <br />