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\ _ <br /> el' .. �Y�., � � �, ,; ..; �A?` i 1Jj1� <br /> "Building an Environment of Compliance " <br /> CALIFORNIA <br /> Environmental Services <br /> Records Authorization <br /> o) , as owner and/or legal representaa of <br /> C.dun4rd 1 clo e p\4 c -12� which contains an underground storage tank <br /> located at 6o- l c_9- Char�rvA 'n the city of rL CA., <br /> hereby authorize a representative of C lifornia Environmental Services to obtain any <br /> and all records pertaining to the maintenance and history of the above referenced tank. <br /> This authorization shall serve for the sole purpose of compiling history information. The <br /> information obtained and released by the local agency and/or the State Water Resource <br /> Control Board shall not be shared with any person or organization without the written <br /> consent of the legal owner or a legal representative thereof. California Environmental <br /> Services shall provide the legal owner a copy of the information received at the request <br /> the legal owner. <br /> Owner:art��, C.E.S.: <br /> Legal Representative Representative <br /> Date: 490�' p 5L <br /> G Tom HtExecn <br /> Accourrc Executive.o. Box 77yi <br /> CltntsHeim CA 9%21 <br /> Tel: 707-9$7-477o <br /> CALIFORNIA Gell:707-9871 <br /> Environmental Services �t'"et <br />