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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <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 LOCATED AT <br /> 7-Eleven #32190 - 4943 South State Route 99 Stockton - Ca 95206 <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE <br /> n/a <br /> (Laboratory) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH <br /> DEPARTMENT AS SOON AS IT IS AVAILABLE AND A THE SAME TIME IT IS PROVIDED TO ME OR MY <br /> REPRESENTATIVE. <br /> BUSINESS NAME 7-Eleven Inc <br /> (If Applicable) <br /> OWNER/OPERATOR: Randy Martin Environmental Manager <br /> (Please print) (Title) <br /> (Owner/Operator Signature) (Date) <br /> ADDRESS: P.O. Box 711 <br /> (Mailing Address) <br /> Dallas Texas 75204 <br /> (City) (State) (Zip Code) <br /> PHONE: ( 800)828-0711 <br /> FH 23 046(,e,i,ed 1 24/02) <br /> Cln,<1rglrep,IIF,3 cn23016 pd Page 5 Wo 11121718 <br />