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'•d •o•Fo of IRUS1EES <br /> J•maa Culp.naon SAt*-QOAOUIN LOCAL HEALTH DISTIa, RT <br /> 'atria. E. vannuccl• S.cy SERVING <br /> Aninon•it• van Spron a.n 1601 East Hazelton Avenue, P. O. Boa 2009 San Joa Gly of lodl <br /> Earl Plm.nlal Ouln County <br /> Fun 9upoa. Stockton, Callfornia 95201 City of Eacalon <br /> Danl•f L. Flora 209/466.6781 City of Manlaca <br /> John 0. Meat, M.D. City of Ripon <br /> William J. WadeCl(y of Slockton <br /> Jopl Kh•nn•, M.O., M.P.M., OIa1rIC1 H••Ilh Ofllcw CI(y of Tracy <br /> Mary Anna lova <br /> San Joaquin county <br /> San Joaquin County <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND ENVIRDEC <br /> c,1 C 1HEq <br /> SITE ASSESSMENT INFORMATION M`•�rAL HES <br /> FERlyllr/SERVICES <br /> It; <br /> 1 , the undersigned owner and/or operator of the property and/or facility <br /> located at . ' ' 1�; i Lrae 1�t �1 , �1 �7 <br /> herebyauthorize <br /> , . .� .L. <br /> " �T / rQPrc -.4.odl <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 /> i representative. <br /> Ownef/Operator: <br /> Title: _ niu. cam„ <br /> Address //�/5/ F �l-J�,�,�T st <br /> Phone: 7 S6 q/35 <br /> K,eo,l <br /> Date: <br /> Ell 08 08 05 LICIT 13 r <br />