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M•ry Ary, LM.Vk*H« <br /> t•Wt.E.v.nnucq+ .r 1601 Ead N419pon Avonuo�P.O.BoK 2009 SEAV�NG <br /> r"'""r jorce C*r ad Lodi <br /> E'K rM►Mid Slocklon• Cd111a•M8 9$201 Son Joaquin Coreh <br /> vlryMb Maffww, 9"Joaquin C..,r <br /> o•r"L Ft,," (209) 466.6191 %of Eacaw" <br /> Jahn 0•Mao.M.D. C*r M Mam*C4 <br /> iD«»I,Kfohafn 4.0 M.P,II,Diable"oft of.r <br /> Gtr N ibddon <br /> Gtr N Trocyl <br /> "ft Joaquin wry <br /> Ut— e 32 <br /> AUTIIORIZATION To RELEASE ANALYTICAL, RESULTS. <br /> SITE ASSESSMENT INFORMATION GEtrt'EC�IC� DATA AND <br /> I . the undersigned owner and/or o er <br /> located at P ator of the property and/or facility <br /> 5 T-o c �o , S <br /> hereby authorize <br /> to release any aA� M CogV <br /> d all analytical resullts� <br /> assessment information to the San Joaquin LocalHe <br /> data and sit` <br /> as it is available and at the same time it <br /> representative , is alth District as soon <br /> Provided to ate or my <br /> Olnerf()Perator: <br /> Ad(I k Nis Ti t le: /G- <br /> SAcro 0; <br /> uacc : S-S- YY <br /> PAYMENT <br /> RECEIVED <br /> [A AY 1 J 1�3 <br /> ]ENVIRONMENTAL HEALTH <br /> EH 08 OS PERMITISERVICES <br /> UGT 13 <br />