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a0AF0 of INUSIEES SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> J.-G. culuen,on. P.aa. <br /> PaUKIa E. Vannvccl, Sac'y, SERVINo <br /> Anlnon.lf• Van sp.on,.n 1601 East Hazelton Avenue, P. O. Boa 2009 s. Cltr or Lodl <br /> Call Plm•nlad nJoagvin County <br /> Fa,n e.,00•• Stockton. California 95201 City or E,calon <br /> Oanfal L. Flora (`'1 209/4W-6781 City of Mant•c• <br /> John 0. Maal, M. /��n\\/ City of Ripon <br /> William J. Wad• Dp u{.i xt City or Stockton <br /> Khanna, M.O,. M.P,N„ OIa1dCl Health 0111cw City o1 Tracy <br /> Mary An Low San Joaquin County <br /> F Eg 2 3 19L7 San Joaquin County <br /> E��N11T/SERV1 ES . <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 9323 N /YJ�//w'i7i 99 <br /> hereby authorize � Al / I- <br /> to release any and all analytical results, geotechnical data and site <br /> assessment infor-mation 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: W�Pii .tCv Fldlzr Title: <br /> Address 65 ,> S' Phone: <br /> Date: <br />[H 08 OS UGT 13 <br />