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ENVIRONMENTAL HEALTH DEPARTMENT_ <br /> SAN JOAQUIN COUNTY <br /> jv & L <br /> Telephone: (209) 468-3420 .Fax: (209) 468-3433MAR 13 2018 <br /> AUTHORIZATION TO RELEASE /VIRDONIIENTAL HEALTH <br /> EP ENT <br /> * ANALYTICAL RESULTS <br /> *GEOTECHNICAL DATA <br /> * ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> i <br /> I,THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY LOCATED AT <br /> T Tracy <br /> r # 1T� '�� ' 1� t' <br /> (Street Address) (City) <br /> HEREBY THORIZE <br /> (,,aboratory) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH <br /> DEPARTMENT AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED TO ME OR MY <br /> REPRESENTATIVE. <br /> BUSINESS NAME: ARP Mini Mart <br /> (ff Applicable) <br /> Owner <br /> OWNER: <br /> Harshad Patel <br /> (Please Print) (Title) <br /> 311/2018 <br /> • (Owner Signature) (Date) <br /> ADDRESS: 25775 Patterso ass Road <br /> (Mailing Address), <br /> / CA 95377 <br /> Tracy <br /> (City) (State) (Zip Code) <br /> PHONE: 51( 0 468 9543 <br /> EH23003B(revised 7-26-2016) 6 <br />