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CDARD-0,F IRUSIEES <br />James culbertson. Pies. <br />Palrtcls E. Vannuccl. Secy. <br />Anihonette van Spronsen <br />Earl Pimento? <br />Fern Bug Dee <br />Daniel L. Flores <br />John D. Mast, M.D. <br />William J. Wade <br />Mary Anna Love <br />SAN*AOUIN LOCAL HEALTH DIST&T SERVINo <br />Clly of Lodl <br />1601 East Hazelton Avenue, P. O. Box 2009 San Joaquin county <br />Escalon <br />Stockton, Calltornia95201 t <br />CCily off MmEm1eit* <br />u <br />209/466$781 City of Ripon <br />City of Slockion <br />I Khanna, M.D. City of Tracy <br />Jog[ , M.P.H., District Health Officer San Joaquin County <br />Sen 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 ///,� 41C1e 4V P S7"ork7-�—N c Jz <br />hereby authorize f4NC4,N, f ly'G/NEER/NG, iNc <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 />Owner/ erator: (/A10Cc A Title: , C. <br />Address 7�� A - A 4 Phone: ?jpq yj r'�G <br />SiaCHra.y C,J/ <br />Date: % iyJAA'r,El kii <br />111 08 05 - 1161 13 <br />