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�vt ts,v�tits SAN JOAOUIN LOCAL HEALT11 DISI 141C1 F SERVING <br />} .mss cutbanson. Pros. CltrolCady <br /> Patricia E. Vannuccl. SOC-7. `Stan Joaquin#Mhorte[le Van Spronaen 1601 East Hazelton Avenue, P. 0. Sox 2009 Q County <br /> ]East Phnonlet 5ltxkton.Galllorn i3 95201 city a t:acaion <br /> E <br /> Fern BsrQbee Cllr of Manteca <br /> Vanlif L. Flores 209146"781 City of Ryon <br /> John D.!Nast. M.D. City al Stockton <br /> City of Tracy <br /> ,William J.Wad* � Jopl Khannk I&D.,M.P.H.,District Health 0111cer San Joaquin County <br /> Mary Anna Law San Joaquin County <br /> AUTHORIZATION TO RELEASE. ANALYTICAL RESULTS. GEOTECHNICAL DATA AND <br /> 1 <br /> SITE ASSESSMENT INFORMATION <br /> 1. the undersigned owner and/or operator of the property and/or facility } <br /> I located atytd5 _ . � � ` ' Sec 1T4�[C�1c� ►n,ePp�jr+atTe Arrf� 1�M-` s <br /> 4hereby authorize <br /> -to release any 'and all analytical results. geotechnical data and site <br />� y <br /> essessoCint information to the San Joaquin Local Health 'Oistrict as soon- <br /> -os it Is'available and at the sante time it is -provided to we or ti0r <br /> presentative. <br /> Wne /Operator: Ti tl e: <br /> _ . :Address Phone: �17 <br />�: _- • � Wit•- � - _ - <br /> Ilate:. J� <br /> : <br /> - <br /> b <br /> F <br /> j}} T <br /> L <br /> I) <br /> F <br /> _ - t <br /> ` v <br /> 1 <br /> . . e <br /> EH 08 05 "UGT 13 <br />