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p <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209) 468-3420 <br /> AUTHORIZATION TO RELEASE <br /> . ANALYTICAL RESULTS <br /> • GEOTECHNICAL DATA <br /> ENVIRONMENTAL/SHU ASSESSMENT INFORMATION <br /> 11 THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATEDAT 1817 S . Fresno Avenue , Stockton , CA <br /> (Street Address) _ _ <br /> trVvv. , try) <br /> P � T w <br /> HEREBY AUTHORIZE (Laboratory or Consultant) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> HEALTH SERVICES AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED <br /> TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: <br /> Barnes Trucking <br /> (I� Applicn6le) <br /> OWNER/OPERATOR: o (Title) <br /> 44 <br /> /lease Priru) <br /> t (Signature) <br /> ADDRESS : <br /> (Mailing Address) <br /> aC & ;c; &i C � GIs7-a6 - <br /> (city) (State) (zip code) <br /> PHONE: ( 2� ) ��I� 3 ' <br /> DATE: PAGE 9 <br /> y / � � 1 � .� <br />