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ENVIRONMENTAL HEALTH DEPARTMENT <br /> ' SAN JOAQUIN COUNTY <br /> Telephone: (209) 468-3420 Fax: (209) 468-3433 <br /> ' AUTHORIZATION TO RELEASE <br /> * ANALYTICAL RESULTS <br /> ' * GEOTECHNICAL DATA <br /> ' * ENVIRONMENTALISITE ASSESSMENT INFORMATION <br /> r <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 RdrStockton, CA <br /> (Street Address) (City) <br /> ' HEREBY <br /> AUTHORIZE_Sunstar_ Labs <br /> _ <br /> ' (Laboratory) <br /> r� <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION ,�O SAN JOAQUIN COUNTY <br /> ' ENVIRONMENTAL HEALTH DEPARTMENT AS SOON AS IT IS AILABLE AND AT THE SAME <br /> TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE, <br /> BUSINESS NAME: PSI <br /> ' <br /> (If Applicable)- 1l <br /> OWNER/OPERATOR: FrpkDepartment Manager <br /> (Plea int) <br /> (Owne peratorSignatur (Date) <br /> ' ADDRESS: 4703 Tidewater Avenue uite B <br /> (Mailing Address) <br /> Oakland CA 94601 <br /> — (City) (State) (Zip Code) <br /> PHONE;X10 434- 00_ <br /> EH 23 046 (Revised 8/1/11) 8 <br /> 1 <br />