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SERVING I <br /> M.,v#--1...,vlc•r,«. 1601 EaA Naiallon Avant, P.O. 504 Mo. sJ"plan C~ty <br /> rou$da G var w cj.G«,V. Jwgv4�C«,M► <br /> 1*^ r hK• Stockton.Calllanla 9S20 M <br /> Carlr4v.M.1 Cky <br /> eksolom <br /> VYfk,Aa MNlwvn (209) 401i•6141 'Cityd MMI«d <br /> 04^W L F$K I:NT M nlvo^ <br /> !NM 0.M44 M.O. Hyl gkw^%MA,M.".msmd Room enc« �Y �� <br /> t <br /> pryd TlOcT <br /> �J��gIM Gel,�b <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> ?� Ithe undersigned owner and/or operator of the /property and/or faciiity � <br /> located at '4 IQL41S- IiJ O.hlknta,-- l )L3.., ( C1;;z', LJ ( I <br /> hereby authorize �Parfvpllg&, �, 1 <br /> to release any and all analytical results, geotechnical data and sit(' <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 /> Owner/Operator: Title: wNST. �1f,/� <br /> Addre:;s '� W , ffs2. ,Q Phone : 444; - -�0E4; <br /> P <br /> us c, R 25' BS <br /> i <br /> EN 08 05 UGT 13 <br />