Laserfiche WebLink
80A'k I UI IIIUSIf LS SAN <br /> SAN IOAUUIN LOCAL HH EALTDISI DICT St kVtNO <br /> � J] �K�t,WIJUlI eOn. Pine. _ <br /> .PalilrJe 1' Vannuccl. Sally la City of t odl <br /> �An U,onntle Van Spronnan 1601 Fast Hazellon Avenuo, P. O. I3ox 2(X19 man Joaq;rin r 'unty <br /> Earl Pimnntel (,try ul f.x'1"Stockton, California 9t)'201 <br /> Fein napban City of Mantnca <br /> -- <br /> Daniel L. Flores 209/466-6781 City of nlpon <br /> y of Stockton <br /> John D. Mast, M.D. city <br /> of Tracy <br /> William J. Wade Jopl Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br /> Mary Anna lore 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 /Oa21'7 . Io-varW A-14.4-..," 99 - _S—Ac44%.j r 64 <br /> hereby authorize Ca/, o,zriJ �a�e.e C/z6 <br /> to release any and all analytical results, geotechnical data and site <br /> dssessment 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: .z� �� Title C <br /> Address Phoney, <br /> Date: <br /> r <br /> i <br /> EH 08 05 UGT 13 <br />