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Jf IAUSIEES SAN JOAQUIN LOCAL HEALTH DISTI ,,CT SERVINo <br /> . <br /> Culbertson. Pies. City of Lodi <br /> ,Acta E. Vonnuccl. Sac y. 1601 East Hazelton Avenue, P. O. Box 2009 Sen Joaquin County <br /> .nihonette van Spronesn Cay of Escafon <br /> Earl Plmentsl Stockton, Callfornia 95201 City of Manteca <br /> Fern euobee 209/466-6781 on <br /> Daniel L Flores City <br /> oof f Stt ocktkton <br /> John D. Mast. M.D. City of Tracy <br /> Willlun J. Weds Jool Khanna, M.D., M.P.H.. District Health officer San Joaquin County <br /> Mary Anna Love 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 -'-'t6Ckt04\ <br /> hereby authorize �rtka6orurtoc��S3401 (4 �ran9� �l„ D Sato <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 /> Owner/Oper4jtor: Title: r J <br /> Address , �r _,zv c_it (t Phone: i/6 ->7z -2Y2 3 <br /> Date: <br /> , r <br /> EH 08 05 UGT 13 s <br />