Laserfiche WebLink
HOARO OE IROSIEES <br />J.m., COtpen'On, Pia'" <br />P.I.Ic I. E. V.nnuCO. Secy <br />Anlhonell• Ven Splonaen <br />E.'I Plmenlel <br />F..n 8.00ee <br />Oanlel L. Flolex <br />John O. Mast, M.O. <br />William J. Wade <br />Mary Anna Love <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1601 East Hauellon Avenue, P. O. Box 2009 <br />Stockton, Callfofnia 95201 <br />209/466-6781 <br />Jopl Khanna, M.D., M.P.N., Oldylcl Health Office, <br />AUTHORIZATION TO RELEASE ANALYTICAL RESULTS. GEOTECHNICAL DATA AND <br />SITE ASSESSMENT INFORMATION <br />1, the undersigned owner and/or operator of the pro arty and/or facilit <br />located at <br />hereby authorize ` <br />to release any and all analytics 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 />re resentative. <br />Owe /Operator: <br />Address 2 (p ( <br />SERVINO <br />C41y of Lodi <br />San Joaquln County <br />City of E acalon <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 />(tt <br />Date: — ZG 7 <br />[if 08 OS DGT 13 <br />