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FILE COPY RECEIVED <br />MAR -13 2017 <br />ENIVIRO ME AL H ALTH <br />ENVIRONMENTAL HEALTH DEPARTM T <br />SAN JOAQUIN COUNTY <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 <br />AUTHORIZATION TO RELEASE <br />* ANALYTICAL RESULTS <br />* GEOTECHNICAL DATA <br />* ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br />I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY LOCATED AT <br />1553 Colony Rd Ripon, CA <br />"161 (Street Address) (009 <br />HEREBY AUTHORIZE <br />Envlro-Chem, Inc (Labo <br />rato)}) <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: Love's Travel Stop <br />((fApplicable) <br />OWNER: Chris Weldon Environmental Manager <br />(Please Print) <br />(Title) <br />3-10-17 <br />c �iLG� (Owner Signature) (Date) <br />ADDRESS: P.O. Box 26210 <br />(htailingAddress) <br />Oklahoma <br />PHONE: ( 405) 302-6673 <br />EH 23 046 (Revised 07/21/10) <br />0 <br />OK 73126 <br />(State) (Zip Code) <br />