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SANJ O A Q U I N Environmental Health Department <br /> COUNTY- <br /> AUTHORIZATION TO RELEASE <br /> N/A <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 /> 1403 Country Club Blvd,Stockton,CA 95204 <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE <br /> (Laboratory) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY ENVIRONMENTAL <br /> HEALTH DEPARTMENT AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED TO ME OR <br /> MY REPRESENTATIVE. <br /> BUSINESS NAME: <br /> UNITED PACIFIC 45446 <br /> (yApplicable) <br /> OWNER: KEN GREEN PRESIDENT-RETAIL <br /> (Please Print) (Title) <br /> Aw 05-15-2021 <br /> (Owner Signature) (Date) <br /> ADDRESS: <br /> 1403 Country Club Blvd. <br /> (Mailing Address) <br /> Stockton,CA 95204 <br /> (City) (State) (Zip Code) <br /> PHONE: <br /> 310-612-9692 <br /> 6of6 <br />