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If0Afit) Or Iif(,',II t S <br />J.�nef?Cciltanl <br />Patric le F_ Vwnnur_cl, <br />Annronella Van Spianlun <br />Eaff Pimenlel <br />Fern D�gboa <br />Daniel L. Flores <br />John D. Mast, M.0 - <br />William J. Wade <br />Mary Anne Love <br />SAN . +A(lIJIN I OCAL I i I AI 1 I I)I ; I <br />"I sivmo <br />(-.fly ul 1 uril <br />1601 Cast Hazellon Avenuo, P. O. 13ox 2(X19 :an Joaquln counly <br />Stockton. California 95201 cfly of I Acaton <br />City of Manleu <br />209/466-6781 City of Ripon <br />City of Stockton <br />Jopl Khanna, M.D., M.P.H., District Health Officer City of Tracy <br />San Joaquin County <br />San Joaquin Cuunty <br />A01110RUA1ION 10 HI 11 MI ANAI VI I(AI Rl all TS, N OII CHNICAI linin ANI) <br />'011 n'',1'r'd91 N1 INI OPMAI I(M <br />I, the undersigned owner and/or operator of the propertyand/or fac;lity <br />located at .2y0,7 <br />hereby authorize '_4� V.eri <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 my <br />representative. <br />Owned•/Operator <br />Address �D _ p y1— 3c1�3S Phone <br />Date: —y ,e7 <br />Ili OB 05 Mr 13 <br />