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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENV1RONMENTAL HEALTH DIVISION <br />(209) 468.3420 <br />AUTHORIZATION TO RELEASE <br />ANALYTICAL PFs>.TLTS <br />• GEOTECHNICAL DATA <br />* ENVIRONMENTALISITE ASSESSMENT INFORMATION <br />T, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br />LOCkTr—r.D AT 301 W. KETTLEMAN LANE, LODI, CA <br />(Srreer AddreSS) (CIry} <br />HEREBY AUTHORIZE SEOUOYA ANALYTICAL IN SACRAMENTO <br />(LQboratory) <br />TO RELEASE ANY AND ALL ANALYTICAL. INFORMATION TO SAN JOA,QUIN COUNTY PUBLIC <br />HEALTH SERVIC13-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: CHEVRON PRODUCTS COMPANY <br />' (If Ap,�licablel <br />oVn4MOPERAiOR: /`e-7,/,- L <br />(Please Prier) <br />n �t r- <br />'A� 0 --- . / xw--- <br />(pwnerjoperator Eign=re) <br />ADDRESS_ P.C. BOX 6D04 <br />(Mailing Address) <br />SAN RASION, CA 94583 <br />(wry) <br />PHONE: (' B 842-8695 <br />EH 23 046 (Revised 9/11/96) page 9 <br />V <br />(Iytle> <br />(Daze) <br />(Stare) (Z=P Cods) <br />