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boARp of lAusitts <br />J.o-rar GWbanson. Pres. <br />Pavia• E. Vannuccl, Secy, <br />Anthonolte Von Spionsen <br />Earl Plmonfol <br />Fein Oupoee <br />Daniel L. Flores <br />John D. Mast, M.D. <br />William J. 'Wade <br />Mary Anna Lora <br />SAN %AOUIN LOCAL HEALTH DIST F ICT <br />%agif *aW <br />1601 East Harellon Avenue, P. O. Box 2009 <br />Stockton, California 95201 <br />209/466-6781 <br />Jogl Khanna, M.D., M.P.N., District Health Officer <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 Al- s -1?f r T s7'ec%'e v c,4 <br />hereby authorize Alp.rz Z:�j c.4,4 ce a K7-j?L c Tio.0 <br />to release any and all analytical results, geotechnical data and site <br />dssessment 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 />Ownef/Operator(All-1�( I'aL4 Title: 0c,,j&&e <br />Address *oN,Z/C rl [ O Phone: X09 y9B (//37 <br />STcclkr'oAt r'A 9j -9e79 <br />III Oil 0'). Illrl 1 <br />SERVINO <br />City of Lodl <br />San Joaquin County <br />City of Eacalon <br />City of Manteca <br />City of Ripon <br />City of Slocklon <br />City of Tracy <br />San Joaquin County <br />San Josoutn County <br />