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'"V1.C1 SAN .17AOUIN LOCAL HEALTH DI51 n!':i sEAvao, <br /> ic,Ae, Culbul,on• e,.,. - <br /> P,I„CIa E. v.nnufcl. $ac'y. �,- City of Lodi <br /> Anlhonalla Van So.on:.n 16(11 Eisl Hazellon Avenue P. 0. 80a 2009il San Joaquin County. <br /> E.n ri,n.nlal Slocklon, Calllomia 95201 city f Esicollon. <br /> Fun aupoaa - <br /> Manteca <br /> Daniel L. flora. X209/466.6781 - City of Ripon <br /> John 0. Mut, M.O. - - City of Stockton <br /> Wallam J. Wada Jopl Khanna, M.O., M.P.M„ olouricl Health oltic" City of Tracy <br /> San Joaquin County <br /> Mary Anna Lova San Joaquin county <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> 1 , the undersigned owner and/or operator of 10 <br /> the property and/or facility <br /> located at iL\ ` 55 �py- Fu LCIAL- QVL-LoW 0, r , C1q"F95376 <br /> hereby authorize CA Ui L Wpt'1 -g- LP'(�,S 1 Y)^"Q.D F S -TD GQ, - <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 /> x _ <br /> Owne�/Operator: �)!Aur. E'9'_1F p�F-_ J S Title: 6G7RAW 17 ;Vr, <br /> Address 2q I >S $;p Cngi(i4(_ 6t_WVd ep _Phone: <br /> 'Ti2�c,Y C't�-ftF. 9s3� 6 <br /> p,��� � <br /> Date: c—� I_).. 19 ._ <br /> it 08 0i 11G1 13 - <br />