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ak,xkc.vt lit usIttS SAN JOAOUIN LOCAL IILALIII [)ISI1` lIC; iT SLRVIHa <br /> James Cult,arlson• P;ns, <br /> PalflCla E- VannuC[1, Sec'yCity of Lod$. San Jpa <br /> Anthonette Van 5p(onaen 1601 East Hazelton Avenge, P. 0. Box 2U{)9 quln County <br /> Ear! Plmentel Slocklon, California 95201 CCiltty of Manof <br /> of Eateca <br /> Fern Bugtree <br /> Daniel L. Flores 209/466-6781 City of Rlpon <br /> John D. Maal. M.D. City of Stockton <br /> City of Tracy <br /> William J. Wade Jo41 Khanna, M.D., M.P_H., District Health Officer San Joaquin County <br /> Mary Ann& Love San Joaquin County <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 n, koC A C—) �) a612)J <br /> hereby authorize ./1%c1 A)j <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 /> Owned/Operator: Title: <br /> Address _ ' d G/i /� I � ] Phone: Qa q <br /> Date: <br /> EH 08 05 UGT 13 <br />