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0 • <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNTY <br /> Telephone: (209) 468-3420 Fax: (209) 468-3433 <br /> AUTHORIZATION TO RELEASE 1 1 E V <br /> ED <br /> MAR 2 9 2017 <br /> *ANALYTICAL RESULTS <br /> * GEOTECHNICAL DATA ENVIRONMENTAL HEALTH <br /> * ENVIRONMENTAL/SITE ASSESSMENT INFORMATION (DEPARTMENT <br /> I,THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY LOCATED AT <br /> —MaW- REi<fi � Z 7 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: CHEVRON SS#208118 <br /> (If Applicable) <br /> OWNER:CHEVRON PRODUCTS CORP. <br /> (Please Print) (Title) <br /> (Owner Signature) (Date) <br /> ADDRESS: <br /> (Mailing Address) <br /> 6001 BOLLINGER CANYON ROAD SAN RAMON CA 94583 <br /> (City) (State) (Zip Code) <br /> PHONE:(925 � 842-1000 <br /> EH 23 046 (Revised 07/17/14) <br /> 6 <br />