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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209) 46&3420 <br /> AUTHORIZATION TO RELEASE <br /> ' ANALYTICAL RESULTS <br /> ' GEOTECHNICAL DATA <br /> ' ENVIRONMENTAUSITE ASSESSMENT INFORMATION <br /> I,THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 618 E. HAZELTON, STOCKTON, CALIFORNIA <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE `;PARnm TFCHNni ony/IIPnRAnjFNT <br /> (Laboratory or ConsuUant) <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 /> BUSINESS NAME: <br /> 0 P Pe C;f es t'4tC (If Applicable) <br /> NArNe <br /> OWNER/OPERATOR: ESTATE OF HICKINBOTHAM, ET.AL. <br /> (Please f) itle) <br /> C <br /> 45 HUNTER SQUARE PLAZA <br /> ADDRESS: g <br /> JKTTOCNddress) CA Y52O2 <br /> (City) (State) (Zip Code) <br /> PHONE: ( 2U9 ) 4b5 5628 <br /> DATE: 31 OCTOBER, 94 <br /> EH 23 041 (Revised 7-10-92) Page* (o <br />