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Jemer cu't'ans in. Pies. <br />Prl•Icla!'.'Vann,. cc[. Secy <br />Anlhonell- Van Spfonsen <br />Earl Ph-iaMal <br />Fern BupDee <br />Daniel L. Flores <br />John 0. Mast, M.O. <br />William J. Wade <br />Mary Anne Low <br />1601 East Hazellon Avenue, P. O. Box 2009 <br />Slockton, Callfornia 95201 <br />209/466-6781 <br />Jopl Khanna, M.D., M.P.H., District Health Officer <br />AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br />SITE ASSESSMENT INFORMATION <br />1, the undersigned owner and/or operator of the property and/or -facility <br />located at OA/' -/-/(: 6-E S q c c'� <br />hereby auth41rriIV1,1 <br />to release any and all analytical results, geotechnical data and site <br />essessment 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: x � � �/l�( Title: 0WIl )aC_ <br />Address `�rf// �. Z i�'� %k'fF Phone: c��8-o2ril <br />COA/ <br />Date:I 7 a%- JP7 <br />EH 08 05 UGT 13 <br />SLAVING <br />City of Lodi <br />San Joaquin County <br />City of Escalon <br />City of Manteca <br />City of Ripon <br />City of Stockton <br />City of Tracy <br />San Joaquin County <br />San Joaquin County <br />IL <br />7 <br />R <br />AUG 11 R9. <br />ENFIERMIT/SERVIC S <br />