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SANJ O A Q U I N Environmental Health Department <br /> COUNTY <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 /> 4501 PERSHINE AVE., STOCKTON <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE <br /> (Laboratory) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY ENVIRONMENTAL <br /> HEALTH DEPARTMENT AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED TO ME OR <br /> MY REPRESENTATIVE. <br /> BUSINESS NAME: <br /> 7-ELEVEN <br /> (If Applicable) <br /> OWNER: 7-ELEVEN INC. <br /> (Please Print) (Title) <br /> (Owner Signature) (Date) <br /> P.O. BOX 711 ADDRESS: <br /> (Mailing Address) <br /> DALLAS TX 75221-0711 <br /> (City) (State) (Zip Code) <br /> PHONE: <br /> ( 800 ) 255-0711 <br /> 6of6 <br />