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ENVIRONMENTAL <br /> HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNTY �t <br /> Telephone: (209) 468-3420 Fax: (209) 468-3433 Ji N ` f` <br /> 0 <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 /> 1960 W.11TH STREET 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#201383 <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 />