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1AR0 or IRUSIEES SAN JOAOUIN LOCAL HEALTH DISTRICT <br /> na, CUItlan]Un, P,... SERVING <br /> MO& E. vannuccf• Sac•y. Gly of Lodi <br /> Ihnnalla Van SPIOnsen 1601 East Hazellon Avenua, P. 0. Box 2009 San Joaquin County <br /> I rimenlet Stockton, Catlfornia 95201 city of[,talon <br /> n fluposa City of IAsntaca <br /> dal L. Florae 209/466.6791 City of Ripon <br /> ,n D. Mast, M.D. City of Stockton <br /> Ilam J. Wade JoGI Khanna, M.D., M.P.H., District Health Officer City of 11acy <br /> y Anna Lova San Joaquin County <br /> San Joaquin county <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> I, the undersigned owner and/ operator of the property and/or facility <br /> located at <br /> iereby authorize <br /> �o release any and all analytical results, geotechnical data and site <br /> assessment information to the San Joaquin Local Health District as soon <br /> is it is available and at the same time it is provided to me or my <br /> epresentative. <br /> nef/Operator �$ <br /> nr <br /> �• T 1 4 Ole 5 Title: <br /> Adress 3, <br /> Phone: —! <br /> ate: 9 <br /> lift 111. III�T 11 <br />