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t)AN JIL)AUUIIV L06AL JILAi_ 1 1i V15 i 1111. <br /> + SERVIhO <br /> JarM• Cul ;e(1;0n. Pfa'$. Clir'01 Uodl <br /> Pay,.iNa,ExVann CCI, Ssey, � i u <br /> San JoaqlnCounl <br /> 1601 East Hazellon Avenue P. 0. Box 2009 r <br /> Anthonall• Van 5pronsen �� City of Eacalon <br /> i fora Ptmentel Slockton,Cal((omia 95201 City of Manteca <br /> fern auab" I°I 209/466-6781 City of Ripon <br /> (-.Oanlel 1»<floret. Cllr of Stockton <br /> John O ;Masl,M•0 City of Bracy <br /> William J.Wade j! JoUt Khanna,.M.0 M.P.H., Dlatdd Health Otflcw San Joaauln County <br /> rotary Anna love r San Joaguln County <br /> AP <br /> e <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS. GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> i <br /> I. the undersigned owner and/or operator of the property and/or faci I ity <br /> located at — <br /> hereby authorizeG ? <br /> to release any and all analytical results, geotechnical data and site <br /> I assessment inforwation 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 /> I <br /> representati ve. j. <br /> f 'j • <br /> I • j9 f / e-,, /, ';err. <br /> Owned/Operator: ,J'r� Title: <br /> . Address I e)o E• 44 �c�� Phone: <br /> • Sic«��'; Com- � - <br /> i <br /> Date: <br /> • `i <br /> S <br /> 1, <br /> k I; • <br /> I!I'i <br /> EH 08 05 UGT 13 �' <br />