Laserfiche WebLink
SAN JOAOUIN LOCAL HEALTH DISI MCT <br /> SLHVINo <br /> oamas Cu,Gertaon„Prey. <br /> Palrlcla E. Vannuccl. Secy. City of Lodi <br /> Anlhonetie Van Spronsen 1601 f ast Hazelton Avenue. P. O. Box 2009 San Joaquln County <br /> Earl Plmenlel , ' Slocklonr California 95201 City of EaCelon <br /> Fern 6u oee City of Manloca <br /> ante)t.. Flores 209/466-6781 Clty of Ripon <br /> John O. Mast. M.O. City of Stockton City of Tracy <br /> William J.Wade Jopl Khanna, M.O.. M.P.H.. Dlalrlcl Haallh officer San Joaquin County <br /> Mary Anna Low San Joaquin County <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS. GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> I. the undersigned owner and/or operator of be property and/or facility <br /> located at M q Q* 7 <br /> hereby authorize <br /> to release any and all analytical results. 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 rq <br /> representative. ' <br /> Owned/Operator: �- f,r �QQ 1�l r Title: j <br /> Address ,Q _ �0y Phone: <br /> �S% C� ' <br /> Date: <br />