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s � <br /> 40ARO Of InuSIEES SAN JO*UIN LOCAL HEALTH DISTRICTS <br /> J•mSERVINO <br /> .� CUIt/an eon, P�•�. <br /> P.uKI. E. Vannuccl. S.c'y. City of Lodi <br /> Anlhonetle Van SPIOnaen 1601 East Halellon Avenue, P. 0. BOK 2019 San JoaQ�ln County <br /> Eall Pimenlel Stockton, Callfornia 95201 C41Yof E&colon <br /> un sup Oea City Of Manteca <br /> anlel L. Flora. 209/466-6781 City of Ripon <br /> ohn O. Mao(, M.O. cl(yolslockton <br /> llllam J. Weds Jopl Khanna, M.O., M.P.H., Olalrld Health Officer San Joaquin city of Tracy <br /> ary Anna Love quln County <br /> San Joaquin County <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> '..M2 law, <br /> 1 , the undersigned owner and/or operator of the property and/or facility <br /> located at v <br /> hereby authorize r,'`; <br /> to release any and all nalytical 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 /> Owner/Operator: Tile: <br /> Address Phone: <br /> Date : <br /> I <br />