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1 li <br /> 1, <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209) 468-3420 <br /> AUTHORIZATION TO RELEASE <br /> • ANALYTICAL RESULTS <br /> • GEOTECHNICAL DATA ; <br /> i <br /> • <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF-THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 900 1/2 E. Victor Road, Lodi , CA. 95240 <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE GeoAnalytical Laboratories !t <br /> (Laboratory or Consultant) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TdUSAN JOAQUIN COUNTY PUBLIC <br /> HEALTH SERVICES AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED TO <br /> ,t <br /> ME OR MY REPRESENTATIVE. <br /> r <br /> I <br /> BUSINESS NAME : TEEESI MICKING. JUC, '} <br /> (if Applicable) <br /> OWNER/OPERATOR ; ,� t 4-,"04,ts+ n X1 C- <br /> (Pleas rint) <br /> I� <br /> (Owner/Opera r ' nature) <br /> ADDRESS: P• 0. Box 1270 <br /> (Mailing Address) <br /> Lodi ,. CA ;; 95241-1270 <br /> Kyry) (State) 00) <br /> PHONE: ( 201 368-2472 <br /> ; <br /> DATE: f� <br /> I� <br /> Page 9 <br /> EH 23 041 (Redsed 7-10-62) <br />