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w ICa/44,ClAfw > ; A. HEALTH DI�uCT _ <br /> of ;1 tt,Al, p srnvnao <br /> rnm iv C.rILor7 srn Pr;q <br /> * Pal11clti r . Vannueel Se)C,v. 1.� Clly of 10011 <br /> i•.. t ne .a Van 1601 E[1;i1 e tlid7_C19 t�Pd !`OVf;n4Sp,:P. 0. DOR 2009 inn.loaqulr Cour; <br /> e rzr��n❑ Y <br /> Clt c1 Fhcnlon <br /> Vol r cnrnl SGod"on Coliforniaa 95201 <br /> torr rvplmr C!1� g7 P.lnNnco <br /> �'�: :r . ;r: JoplI(hnnnn, R76A M �"'r6-1., UIrJ9rlc1lina191a4t11ocvr An Anr qlir oun';, <br /> I ri Lum San ,o:l do County <br /> AUISOR1ZATION TO RELEASE ANALYUCAL RESCI0.,'1'S.-GEOTECHNICAL DATA AND <br /> SIR ASSESSPL M INFORMATION <br /> 1 ; ;.he undersigned owner and/or asOrnr<ator of fliplrtalaerty andlor facility <br /> located at -5/ad C, Ahe 1-eS17ti - S &;vo�(Asn - <br /> hereby authorize � <br /> ,o release any and all analyticyl i sulps,, Icaxteehnical data and site <br /> sses%went information to the S�atl '"Ina uilulowII Health District as son), <br /> as it is available and at the same t1111e it, if, pr®vided to me or my, <br /> reps esentative. <br /> 61c-"je 7( l fn� le t pyG 7- <br /> Owncr✓01r*rotor: - eh <br /> 4 W 1a7j g� i12G ,zc �e/� Yitle: ficT"'.� e <br /> _W 6'x'7 2 , D G-C cs zs�—P`hone: Q—._lQ �l-- <br /> Date: //- 7 5-- -- - - ---- <br /> a <br /> EH OB 05 UGT 13 <br />