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•wet ' —...... ..... ` '-Wt� <br /> t ik1a�E. Vannuccl. SeCy: San Joaquin County <br /> I�Adnatle Van Spronaen <br /> 1601 East HazcNon..Avenue, P. O. Box 2009 City ofEacail5n. <br /> 209/466fi781 <br /> .rlvlmeniat - Stockton.-Callfornia 95201 City ofXnt w{ <br /> yin BupOee: - CltyoLR, tpo. <br /> x 1 Floiet yCJIY°t <br /> Mtal.'M.D. Ctly'o • <br /> IIIam:J.Wade Jog[ Khanna, M.D.. M.P.H.. Diatrl'ct Hoolth Officer San Joaquin County. <br /> `Anna Love San Joaquin County,_ <br /> .. . , <br /> q 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 /> tai' _. ._ d•✓ C //F. M <br /> ,r <br /> located at <br /> fix, hereby authorize /�� l✓ �Tr <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 /> Cis it is available and at the same time it is provided to me or my d <br /> kti;�.representative. <br /> s� •r <br /> 4Q <br /> 0{+ne�/Operator: <br /> Title: <br /> Address Phone: <br /> aLL<:i <br /> a Date: <br /> It <br /> 1r r <br /> c <br /> 5 r <br /> P l <br /> .. '4-M S.. -._..ern+...w-��� .w........�•...-.-.-._....:....,-.. .,wn�""'! <br /> EH 06 05 •.;jUGT 13 <br />