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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209)468-3420 <br /> AUTHORIZATION T4 RELEASE . <br /> *'ANALYTICAL RESULTS <br /> *.'GEOTECHNICAL DATA <br /> ,3 <br /> * ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE.PROPERTY AND/OR FACILITY <br /> LOCATED AT 333_ Tuleburg Levee, Stockton CA 95202 <br /> (Street Address)': (City) <br /> HEREBY AUTHORIZE Ground Zera Environmental I�I <br /> ;(Laboratory) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> i; <br /> HEALTH SERVICES-ENVIRONMENTAL HEALTH DIVISION AS SOON AS IT IS AVAILABLE AND AT THE SAME <br /> TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: Waterfront!Yacht Harbor <br /> (If Applicable) T <br /> OWNER/OPERATOR: Waterfronta,Yacht Harbor <br /> {Ple rine) (Title) <br /> caner/ o gnature) (Date) <br /> ADDRESS: 4505 Preci ssi Lane, Suite _B <br /> (Mailing Address) <br /> Stockton :. CA 95207 <br /> (City) (State) (Lip Code) <br /> PHONE: ( 209 ) 473-20Q1�� <br /> k <br /> x <br /> EH 23 046 (Revised 10/19/98) Page 9 <br />