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80ARO OF 1RUSICES , SAN- -JAQUIN LOCAL HEALTH DISTr-..C,T SERVING <br /> Jame cuitenaon, Pre%. Clly of LO01 <br /> Patricia E. Vannuccl, Secy. <br /> Anlhonetle Van Spronsen 1601 East Hazelton Avenue, P. O. Boz 2009 San Joaquin County <br /> City of Escalon <br /> Fer Plmenlel Stockton, California 95201 city of Manteca <br /> Fern 6upDea <br /> Daniel L. Flores 209/46"781 City of Ripon <br /> John D. Mast, M.D. City of Stockton <br /> City of Tracy <br /> William J. Wade Jog[ Khanna, M.D., M.P.H., District Health Officer Sen 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 I � � �� <br /> hereby authorize A(ottTai CAt ('� .v<T,rt; r;�•;.r <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 /> J <br /> Owned/Operator: � � Title: �n � <br /> Address Z ti7ff' G ,AIT Phone: <br /> :�_relrAE-A/ <br /> Date: �2 y ,-k4 <br /> IH 08 05 , UGT 13 <br />