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IIJAh <br /> Amev or rt,on. ,. SANnAOUIN LOCAL HEALTH DISTRICT <br /> Jamee Culoen son, Pea. SERVING <br /> Particle E. Vannuccl, Secy. <br /> Anlhonefle Ven Spronsen 1601 East Hazellon Avenue, P. Cl. Dox 2009 Sen Jo, Clly or Lodi <br /> Earl Pimenier Quin County <br /> Faro Oupoee <br /> Slocklon, California 95201 city of Escaion <br /> Daniel L. Flores 209/466-6781 city Of maniac, <br /> John D. Masi, M.D. City of Ripon <br /> WadeCity of Stockton <br /> Miriam J. Love Jopl Khanna, M.O., M,P.H„ Dlelrlcl Health Officer City of Tracy <br /> Aary Anna Low _ Sen Joaquin County <br /> San Joaquin County <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> 1 , 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 /> Owne�/Operator: Title: <br /> Address �'/ <br /> Phone: <br /> i <br /> 1 01i o" III,I 1 i <br />