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oIV <br /> ENVIRONMEN AL HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNTY <br /> Telephone: (209)468-3420 Fax: (209) 468-3433 <br /> AUTHORIZATION TO RELEASE <br /> Ar <br /> *ANALYTICAL RESULTS <br /> V�\� *GEOTECHNICAL DATA <br /> \(� ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> 1,THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 2908 Benjamin Holt Drive Stockton <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE <br /> (Laboratory) <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 <br /> TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: ARCO (Loc. No. 2133) <br /> (If Applicable) <br /> OWNER/OPERATOR: <br /> Leon Hatch <br /> (Please Print) (Title) <br /> (Owner/Operator Signature) (Date) <br /> ADDRESS: <br /> (Mailing Address) <br /> (City) (State) (Zip Code) <br /> PHONE:( 510 432-8397 <br /> EH 23 046 (Revised 8/3/07) <br /> 4 <br />