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0OAHO Of TRUSTEES SAN JOAQUIN LOCAL HEALTH D 'RICT <br /> SERyING <br /> L.x«CWMMen,P'«. .�. .r <br /> Mwv Anne Leve,vice Px«. 1601 East Hecellon Avenue, P.O.8or 2009 Ceunty <br /> P 84ftW C Vennuocl,t«y. . Ton 4m <br /> Te~ay Jerre Stockton,C•IllornIs 95201 �a Co"M y <br /> 4E aft PwneMel CNy et r.caf x <br /> Wok'"Melhe" (209) 466.6111 City*(Man("* <br /> o.nM L flee. <br /> CNy at(uyen <br /> Jam 0.Meet,MA. JpI KA.M►Mp.MlJI,OIeY1t1!{eelih ONew CMY el StaCki n <br /> o«» tai Kr.heT CNy et Tracy <br /> 9"Joaquin County <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> A <br /> i , the undersigned owner and/or operator of the property and/or facility <br /> located at _ 1 f C' e <br /> hereby authorize <br /> r <br /> to release any and all analytical results, geotechnical data and sit4 <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 /> s <br /> representative . <br /> e� <br /> Owner/Operator: Title: (1/LcJ/W/i. <br /> Addre_;s Phone: <br /> �i <br /> .T <br /> fkk Date , <br /> f <br /> EH 08 05 UGT 13 <br />