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SA N J U A Q U N Environmental Health Department <br /> COUNTY <br /> AUTHORIZATION TO RELEASE <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 /> 4747 West Ln, Stockton <br /> (Street Address) (Cite) <br /> HEREBY AUTHORIZE <br /> BC Laboratories, Inc. <br /> (Laboratory) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT AS SOON AS IT IS AVAILABLE AND AT THE <br /> SAME TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE, <br /> BUSINESS NAME: West Ln Chevron <br /> (If Applicable) <br /> OWNER/OPERATOR: Ravinder9itngh Owner <br /> (Please Print) (Title) <br /> (OwnerlOperat Signature) IDgIeT <br /> ADDRESS: 4747 West Ln, <br /> (Mailing Address) <br /> Stockton, CA 95210 <br /> (City) (State) (Zip Code) <br /> PHONE: (209 992-1735 <br /> 8ot10 <br />