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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 />TsT:l9:ciI`.i►1Lim 110—TV0 <br />* ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br />I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br />LOCATED AT 342 N. Hunter, Stockton, CA 95202 <br />(Street <br />tical Laboratories (City) <br />HEREBY AUTHORIZE Y <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: <br />OWNER/OPERATOR: <br />ADDRESS: .sin A. hi uorauo ou. <br />(Mailing Address) <br />St John's Episcopal Church <br />(!f Applicable) <br />;ockton, CA 95202 <br />(City) (State) (Zip Code) <br />PHONE:( 209 )466-6916 <br />EH 23 046 (Revised 10/19/98) Page 9 <br />