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ao.aOOr INUSII(S SAN JOAOUIN LOCAL HEALTH DISTRICT <br /> �.T.. Culu.n.on. P'... SENVINO <br /> P•tl<I. t. V.nnuccl, S.c'y Clly of Lodl <br /> Anthon.aa Va. Sn.on,.n 1601 East Hazellon Avenue, P. O. Box 2009 son Joaquin County <br /> E.,I Pin..m.i Stockton, California 95201 City of Eacdon <br /> f•'n Oopo.. City of M.m.c. <br /> canlaf L. Ffor.. 209/466-6781 City of Ripon <br /> John O. Matt, M.O. CRY of Slocklon <br /> William J. Wade Jopl Khanna. M.O., M.P.N., olaldct Health office, CITY of Ttaay <br /> Mary Anna Loy. San Joaquin County <br /> San Joaquin County <br /> PIP <br /> f tX*q, <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS. GEOTECHNICAL DATA AND �EC3 pV <br /> SITE ASSESSMENT INFORMATION ENVI lye <br /> ' F fRM IisFRVi�SLTh <br /> 1 . the undersigned owner an or operator of the proprty and/or facility <br /> located at --_21 `� � �1//CePi oC'c< , <br /> hereby authorize <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/Operator: Title: <br /> Address <br /> Phone: J� — :3 7g-Z-_ <br /> Oatc: <br /> Oe l l'Z —oto ?-, <br /> 1/ no nc nr:r 1 I <br />