Laserfiche WebLink
BOARD of TRUSTEES - SAN JOIKOUIN LOCAL HEALTH DISTRICT SERVING <br /> James Culbertson, Pres. Clly of Lpol <br /> Patrlrla E. Vannuccl• Secy <br /> Anthonelte Ven Spronson 1601 East Hazelton Avenue, P. O. Dox 2009 Son JoaqulnCounty <br /> City of Escslon <br /> Earl Pimento Stockton, California 95201 City of Manteca <br /> Fern Bugoes <br /> Danlel L. Flores 209/466-6781 City of Ripon <br /> John D. Mast. M.D. City of Stockton <br /> William J. Weds Jopl Khanna, M.D., M.P.N., District Health Officer City of TracySan Joaquin County <br /> Mary Anna Love 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 �G <br /> hereby authorize <'�.t�i ti'ir �1 r i '� , . ��rr�- .Srxz L")C S <'.- <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 /> /Ty t ze .Z <br /> Owner/Operator: �� t � ��, c�,I Title: <br /> Addrea <br /> .�- < / /�� . /' sy- Phone: <br /> Date: <br /> V <br /> 5 r�p,�v�CrLS <br /> e <br /> EN 08 05 UGT 13 <br />