Laserfiche WebLink
90r 110 OF IRUSTEES <br />Jamas CulheftqSo, <br />Palrlcle E. Ven <br />Anlhonette Va <br />HEALTH <br />Earl Plmenlel <br />Fern Bupbee <br />SERVING <br />Daniel L. Flores <br />John D. Mast. M.D. <br />William J. Wade <br />San Joaquin County <br />Mary Anna Lore <br />Stockton, California 95701 <br />1W <br />SAN JOAQUIN LOCAL DISTRICT <br />HEALTH <br />SERVING <br />City of Lodi <br />1601 East Hazelton Avenue, P. O. Box 2009 <br />San Joaquin County <br />. <br />/�` <br />� <br />Stockton, California 95701 <br />City of Escalon <br />J <br />City of Manteca <br />209/466-6781 <br />City of Rlpon <br />,. <br />City of Stockton <br />Jopl Khanna, M.D., M.P.M., District Health Officer <br />City of Tracy <br />San Joaquin County <br />San Joaquin County <br />xf <br />AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA��y9�`.•yt w X <br />SITE ASSESSMENT INFORMATION <br />1. <br />o the undersigned 91e�and/ grlopgma - A- .perty and/or facility <br />located at SS'' �l�tjj ,Ijr <br />hereby authorize - 5 R 110 0 1 k 0 tum <br />to release any and all analytical results, eotechnical 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. ,7 1q �P� IiNA �I <br />V � I (� <br />Owner/Operator: 10 <br />c1 1 Title: � l� �(X <br />Address I Phone: �pOq <br />Date: ��� <br />ru nn nr. ncT 17 <br />