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1 � � <br /> 1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNTY <br /> Telephone: (209)46&3420 Fax: (209)468-3433 <br /> AUTHORIZATION TO RELEASE <br /> *ANALYTICAL RESULTS — <br /> 'GEOTECHNICAL DATA <br /> ENViRONMFNTAU,9MASSESSMENT WFORMATION <br /> 1,THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT Northeast corner of Farmington Road and E Mariposa Rd Stockton, CA <br /> ' (SiraelAddresrs) <br /> HEREB <br /> AUTxORi2E ....,...._.._."....__.�"....(ClfyJ �.�_�._._— <br /> mHO- Sunstar Labs <br /> I (Labe�arory) ' <br /> ' TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT AS SOON AS IT IS AVAILABLE AND AT THE SAME <br /> TIME 1T 1S PROVIDED TO ME OR MY REPRESENTATIVE. <br /> BUS1NdSSNAML: Walgreens <br /> ((fAppficable) " <br /> OWNER/OPERATOR; Waiter Hocutt , <br /> �.�(l7mler/OperatnrSYgneF¢ra) (Dafe) <br /> ADDRHSS: <br /> ' '7 E. 3rd Avenue <br /> (MallIng Ad&ess) —111-1 <br /> San Mateo CA 94401 <br /> I (City) (Slate) (Llp Code) <br /> PHONE:( 10 _)434-9200 <br /> GCT 2 6 211 <br /> iEH23046 (RevkedS/1111) <br /> I <br />