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State Of California Department of Resources Recycling and Recovery(CalRecycle) CalRecycle 741 (New 12/11) Property Access Authorization and Non-Responsibility Affidavit For Private Property ,, Rick Martinez ,certify that I am the legal owner, or authorized agent of the legal owner, of the property located at the following address 20100 Wicklund Rd,Tracy,CA 95391 and have the authority to grant access to the property. Neither I, nor any resident, invitee, licensee, lessee or person I inherited from, personally brought any of the subject waste tires onto my property. Nor did I,or any of the above,direct,authorize, permit or otherwise provide consent to another to bring the tires on illy property. Specifically, to the best of illy knowledge the circumstances of how the tires were brought onto my property,and the manner in which 1 became aware that the tires were on my property, are as follows: 50+ tires illegally dumped along district property I hereby authorize the city or county representatives applying named San Joaquin Regional Conservation Corp their designated contractors and representatives,and other state and local agencies authorized to access to the property described below for the purpose of removing tires. This cleanup is being performed under the Local Government Waste Tire Cleanup Grant Program. understand that by signing authorization to access the property, I am not admitting liability or responsibility for the cleanup of the property. I declare, under penalty of perjury,under the laws of the State of California,that all the above information is true and accurate to the best of my knowledge and belief. The West Side Irrigation District Name of Property Owner Srgnature of Property Owner 20100 Wicklund Rd, Tracy, CA 209-310-11 Address Parcel Number (209) 835-0250 Telephone Date AG-40 Parcel Zoning