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ENVIRONMENTAL HEALTH DEPARTMEW <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 ONdNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY LOCATED AT <br /> 1442 COLONY ROAD RIPON <br /> ( Street Address) (Cit)) <br /> HEREBY AUTHORIZE <br /> MCCAMBELL ANALYTICAL LABORATORY <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#210997 <br /> (If Applicable) <br /> OWNER: CHEVRON PRODUCTS CO. Zee <br /> . <br /> (Please Print) (Title) <br /> (Owner Signature) (Date) <br /> ADDRESS : P . O . BOX 6004 <br /> (Mailing Address) <br /> SAN RAMON CA 94583 <br /> (City) (State) (Zip Code) <br /> PHONE : ( 925 ) 842 . 9002 SAN RAMON CA 94583 <br /> EH 23 046 (Revised 07/ 17/ 14) <br /> 6 <br />