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aOaaD Of Inul1((S <br />J.Inaa L%dpanson. P,a%. <br />VAI.Kla E. VannufCl. SaC'y. <br />Anlnonalla. van S9&on»n' <br />Eul rlmanl al <br />F in BvDOaa <br />oanlal L. Flofu <br />Jon" 0. Mast. M.O. <br />William J. Wade <br />Mary Anna Lova <br />SAN JOAQUIN LOCAL HEALTH 015 i 1 �11r- <br />I6dr7 st Hazelton Avenua. P. O. Boa 2009—'Y <br />Stockton, Calllo(nia 95201 <br />209/466.6781 <br />Jopl Khanna„ M.O., M.P.H., olalnct Health Ot(ket <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 O,�Oc{ Q �CIcYII l� /� lv ' <br />hereby authorize U4,1.( S- w�> 1f » 11 w���"� <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 />S(RV IpO <br />City o1 Lodi <br />San Joapuln COunly. <br />City o1 Ea;oton. <br />City OI Man/aGa <br />City of Rlpon <br />City of Slocklon <br />City of [ucy <br />San Joaquin County <br />San Joaquin County <br />Cwne�/Operator: ��q-Ye�t��t Title: _Q i �'–s�. <br />Address /97d C i!<eA7o� �itJ�y Phone: aa9-95�/-.3�7/ <br />,57o <br />�7d 14 <br />Date: __,j� fv-{s– – -- <br />u 013 a, U(:1 13 <br />