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II)A <br /> "u of it" `'" ty %rS,V X)AOWN i OCAL IiLAL i44011N%ortIC1 <br /> -.,nye. Cvilen>on, Pree <br /> gLIcl. E. Vnnnuccl. Secy GI, of I odl <br /> -'nlhonena Lan Spion,en 1601 Last I azellon Avenll0, h. (). Box 4 ` ' i �4n Joauln nly <br /> "aal plmantel $lOcklOn, Caillorn is 95?O1 ��1 f .',,i: !I y C.ov <br /> City of Facaiun <br /> urn Bulluee �n" JI City of Maniacs <br /> ,niel L. Flores 209/466-6781 'I:. _ City of Ripon <br /> '>hn D. Maat, M.D. ('�,h�; c: City 0!Stockton <br /> '£illam J. WadeCity of Tracy <br /> Jopl Khanna. 61.D., M.f'.li., Dletrlcl Health Officer <br /> `-cry Anna Lore <br /> EHi=ALb JnequlnCounty <br /> FERMII/SERVICES Sen Joaquin Counly <br /> AUTHORIZATION TO RELEASE ANALYTICAL. RESULTS , GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> I , the undersigned owner and/or\ operator of the <br /> `property and/or facility <br /> located at <br /> hereby authorize C'G,\n ,=C_ �� � <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 /> Ownef/Operator: i Title: jj� #/�ft <br /> Address Phone: <br /> C°A • qti'110 _ <br /> Date: <br /> 'i)W :l _ <br /> ENVIhu:v:t:vTAL HEALTH <br /> FERIAIT/SERVICES, <br /> u� B <br /> FH 08 05 UGT 13 <br />