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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <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 5000 So. Airport Way Stockton <br />(Street Address) (City) <br />HEREBY AUTHORIZE R M C I <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 <br />TO ME OR MY REPRESENTATIVE. <br />BUSINESS NAME: U S DEPARTMENT OF TRANSPORTATION <br />(If Applicable) <br />OWNER/OPERATOR: <br />(p e Print) (Title) <br />v s s C / / / 9 4 <br />ADDRESS: 10275 OLD PLACERVILLE ROAD <br />(Mailing Address) <br />Sacramento Calif 95827-3044 <br />(City) <br />PHONE:( 916 <br />DATE: <br />551-3406 <br />EH 23 041 (Revised 7-10-92) Page 9 <br />(State) (Zip Code) <br />