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11 <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />SAN JOAQUIN COUNTY RECEIVED <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 NOV 13 2015 <br />AUTHORIZATION TO RELEASE ENVIRONMENTAL <br />HFAITW ncoecTaer=kiT <br />* ANALYTICAL RESULTS <br />* GEOTECHNICAL DATA <br />* ENVIRONMENTAUSITE ASSESSMENT INFORMATION <br />I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY LOCATED AT <br />192 Lathrop Road Lathrop 95330 <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: Colonial Energy #40135 <br />(If Applicable) <br />OWNER: Salaheddin Hassan Manager <br />(Please Prinf) (Title) <br />ADDRESS: <br />(Owner Signature) <br />2860 N. Santiago Blvd. 2nd Floor <br />PHONE: ( 714 <br />EH 23 046 (Revised 07/17/14) <br />(Mailing Address) <br />Orange <br />761-5426 x 230 <br />(City) <br />9 <br />_11/2015 <br />(Date) <br />CA 92867 <br />(State) (Zip Code) <br />