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Anlhunalla Ven .`.p,on,en <br />E eft Plmenlel <br />Fern BupUee <br />Daniel L. Fiore, <br />John 0. Mall. M.D. <br />William J. Wade <br />Mary Anne Love <br />. a.. J.ii.UUli� 11/1,r�L III_r�t II1 ;�I1111�1 <br />r � .'.I uPlrrO <br />1601 Cast flafellun Avenuo, P. O. UD■ 20(19Crty of 1 udl <br />San JO,QuIn County <br />Stockton. California 95201 city of E,calon <br />209/466-6781 City Of Menleca <br />City of Ripon <br />City Of Slochton <br />Jopl Khanna. M.D., <br />M.P.H.. o1alricl Health Officer City of Tracy <br />Sen JoaQuln County <br />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 _�) c7 40 7i; Tl, . _ _ _ . : I <br />hereby authorize Gv� t° <br />�• l a�Z <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 />Ownef/Operator:Title: <br />Address sy / Phone:�7� t/ S <br />Date: <br />EH 08 05 UGT 13 <br />