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uocu,.wgn tnvempe iu: 1UJA0U44ru <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNTY <br /> Telephone: (209) 468-3420 Fax: (209) 468-34R <br /> EC;E I V E D <br /> AUTHORIZATION TO RELEASE DEC 2 7 2016 <br /> ENVIRONMENTAL HEALTH <br /> * ANALYTICAL RESULTS DEPARTMENT <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 /> 350 West Grantline Road Tracy, California 95377 <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 <br /> (If Applicable) <br /> OWNER: Dwight Larsen Director cf Gas Operations <br /> pocu5igned by: (Please Print) (Title) <br /> . (A , 12/21/2016 <br /> B31BF67C58EBOD (Owner Signature) (Date) <br /> ADDRESS: P .O. Box 35005 <br /> (Mailing Address) <br /> Seattle WA 98124 <br /> (City) (State) (Zip Code) <br /> PHONE: (425 313-8100 <br /> EH230038(revised 7-26-2016) 6 <br />