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,mer Culueneon, Free, <br />■l,icia E. Vannuccl, Secy <br />nlhonelle Ven SPIonsen <br />off Plmentel <br />ern Dupbee <br />anlel L. Flores <br />)hn D: Meet, M:D. <br />iilinm J. Wade <br />ary Anna Love <br />1601 EaeHazelton Avenue; P. O. Box 2009 1*40, <br />Slockton, Callfornia 95201 <br />209/466-6781 <br />Jopl Khanna, M.D., M.P.H., District Health Officer <br />AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br />SITE ASSESSMENT INFORMATION <br />I, the undersigned owner and/or operator of the <br />located at S'. <br />facility <br />hereby authorize U �w <br />to release any and all a alytical 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 my <br />representative. <br />City of Lod$ - <br />San Joaquin County <br />City of Escaton <br />City of Manteca <br />City of Ripon <br />City of Stockton <br />City of Tracy <br />San Joaquin County <br />San Joaquin County <br />Y cA-6qrS <br />Owned/Operator: V, 17�6c4 Title--X?P F1 <br />k -f <br />Addresses %� 45 Phone: k 546/ �4- 1?3 Vy' <br />CL. • <br />Date:�C <br />i <br />e <br />I <br />EH 08 05 UGT 13 <br />