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L l i <br /> .'.111 L'111(l <br /> r 1 C.., t..•",fnn. r ..ti City of l udl <br /> AN. O l71K1`.? <br /> /--1:1 <br /> :an Joaqutn Cuunty <br /> vt:reuo �a<1,uneLfa Van Spmnsen City of Escaton <br /> elmenfei_ Stockton, Calllor�ia 95201 City of ManleCS <br /> F ern OugDee 209/466-6781 City of Rlpon <br /> ■nlef C. Flo,et City of SloCkton <br /> J_onn D. Mail. M-0City of Macy. <br /> MLlfll■m J. Wada Jopl Khanna, M.D., M.P.H., Dist(ICI F1eaflh Olflce( <br /> t• San Joaquin County <br /> San Joaquin Cuunly <br /> M-ary Anna Love <br /> l <br /> ! AUTHORIZATION TO RELEASE ANALYTICAL RESULTS. GEOTECHNICAL' DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> I , the undersigned owner and/or operator of the property and/or facility <br /> located at <br /> hereby authorize <br /> to release any and all analytical results, eotechnical data and site <br /> assessment information to the San Joaquin Local Health District as soon <br /> as it is available and at the same time it is provided to me or my <br /> 1 ti <br /> representative. ' <br /> Owner/Operator: Title: <br /> Address C) . (?aux I Phone: 3 3 8f— <br /> Date: <br /> f <br /> EH_.08.05 UGT 13 <br />