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ENVIRONMENTAL HEALTH DEPARTMENT <br />SAN JOAQUIN COUNTY <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 <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 />2285'P- Fremont Street 4tnrkton, CA 95205 <br />(Street Address) (City) <br />"i ts/e I C <br />HEREBY AUTHORIZE <br />�d/igt'/)yt/A S -1A)C. <br />ratory) <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 TIME IT IS PROVIDED TO ME OR MY <br />REPRESENTATIVE. <br />BUSINESS NAME: Quik Stop Mrarkets <br />(If Applicable) <br />OWNER: Michael Karvelot <br />(Please Print) <br />ADDRESS: <br />PHONE: (5 10 ) 657-8500 <br />EH 23 046 (Revised 07/21/10) <br />2285 E. Fremont Street <br />(Mailing Address) <br />Fremont, CA 94538 <br />(City) (State) (Zip <br />0 <br />(Title) <br />