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bo'kRo Or IaaUSIEES SAN .JOAOUIN LOCAL HEALTH DISTRICT <br /> Jlmas Cvluarlson, Pros. SERVfHt] <br /> Palrlc1a E. v•nnuccl, SaC'y, CltyolLodt <br /> Anlhonall• Van Spronsen 1601 East Hazelton Avenue, P. 0. Box 2009 San Joaquin <br /> Ear! Pimantst County <br /> Stockton, California 95201 City ofEscalon <br /> Earn eupneaCity <br /> Daniel L. Florae 20g�46b-S78i an1ponn <br /> City ofpl <br /> John D. Mast, M.O. City of Stockton <br /> William J. Wada J091 Khanna, M.o.. M.P.H„ fJfatrtd Haallh 011lcor City of Tracy <br /> Mary Anna Lora S&A Joaquin County <br /> Sart J. Cutn County <br /> AUTHORIZATIOU TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA NO <br /> SITE ASSESSMENT INFORMATIOK <br /> a .. <br /> 1 . the undersigned owner and/or operator of the property and/or 'faci l ity <br /> located. at Ile <br /> i <br /> hereby authorize <br /> to release any and all anical results <br /> a yt , geotechnical 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 /> representative. _ <br /> i V <br /> Owner/Operator: <br /> Address Title: j�c�� <br /> �J t'cJ / �� Phone: —5/40 0 <br /> f <br /> ,if 08 05 UGT 13 <br />