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PUBLIC HEALTH SERVICES <br />SAN JOAQUIN COUNTY = c <br />JOG) KHANNA M.D., M.P.H. <br />Health Officer <br />P.O. Box 2009 . (1601 East Hazelton Avenue) Stockton, California 95201 <br />(209)468.3400 <br />JAN <br />ENVIRONMENTAL HEALTH DIVISION ENl/iEWll171CLlnl,, <br />(209) 468-3420 <br />�'cR�:i;Ti ��nv"i <br />AUTHORIZATION TO REL_EA_c=t 1= <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 2040 West Washington Street Stockton <br />(STREET ADDRESS) (CITY) <br />HEREBY AUTHORIZE Kennedy/Jenks/Chilton <br />(LABORATORY or CONSULTANT) <br />TO RELEASE ANY AND ALL ANALYTICAL RESULTS, GEOTECHNICAL DATA AND/OR <br />ENVIRONMENTAL/SITE ASSESSMENT INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br />HEALTH SERVICES AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS <br />PROVIDED TO ME OR MY REPRESENTATIVE. <br />BUSINESS NAME: CAL -FARM SUPPLY COMPANY <br />fIF APPLIF.PBLE1i <br />TR STEE N BANKRUPTCY <br />OWNER/OPERATOR: CHARLES R. WHITWORTH, CASE NO. 287-04176-A-7 <br />(PLEASE PRINT) (TITLE) <br />(SIGNATURE) <br />ADDRESS: Post Office Box 180 <br />(NAILING ADDRESS) <br />West Sacramento, CA 95691 <br />(CITY) (STATE) (ZIP) <br />PHONE: _(gtF ) 372-5312 <br />DATE: January 4, 1989 <br />EH 23 041 Revised 10/89 <br />A Division of San Joaquin County He J+ Grr Sen'ir" <br />