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ENVIRONMENTAL HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNTY <br /> Telephone: (209) 468-3420 Fax: (209) 468-3433 <br /> AUTHORIZATION TO RELEASE ENVIRONhIENTAL HEALTH <br /> ps�Zf4i'tTISERVICES <br /> *ANALYTICAL RESULTS <br /> * GEOTECHNICAL DATA <br /> * ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> 1,THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY LOCATED AT <br /> 3250 W. Grantline Rd Tracy <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE <br /> (Laboratory) <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: Costco Wholesale, Inc. <br /> (If Applicable) <br /> OWNER: Dennis Bock Compliance Manager <br /> (Please Print) (Title) <br /> For Dennis bock 02/22/2016 <br /> (Owner Signature) (Date) <br /> ADDRESS: 999 Lake Dr. <br /> (Mailing Address) <br /> Issaquah WA 98027 <br /> (City) (State) (Zip Code) <br /> PHONE: (425 } 427-7653 <br /> EH 23 046 (Revised 07/17/14) <br /> 6 <br />