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,j". Cuto.naon, Pr... <br /> SAf -)AOUIN LOCAL HEALTH DIST F,. -;T <br /> Patricia E. vannuoa. Sac•r SERVING <br /> 4nfhonatla van spronaan 1601 East Hazelton Avenue, P. O. Box 2009 ctlr a Lodi <br /> Earl PMwanlal San Joaquin qty <br /> Fara 8"boa Stockton, Callfotnla 95201 City of Eacaion <br /> Dante.I fes„ 209/466.8781 clly of Manteca <br /> John 0. Mast M.O. City of Ripon <br /> 4Vlttlanf J. W&" J 1 Klan City of Stockton <br /> MWY Anna Low oQ nk M.D., M.P.H., District Health Officer City of Tracy <br /> San Joaquin County <br /> 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 the property and/or facility <br /> located at <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 my <br /> representative, <br /> Amey/Oper�Ltor_ C <br /> Address Title: k <br /> Phone: <br /> Date: �G —,� 2 <br /> EH 08 05 UGT 13 r r <br />