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SAN IrJAUUIN LOCAL HLAL1 H DISI HILT <br /> 2arnei Cutt+enson. Pie,. SLRVINO <br /> Palrlc• f. Vannuccl, Secy. Clly of Lodi <br /> Anlhonetle Van Spronsen 1601 East Hazelton Avenue, P. 0. Box 2009 San JoaqulnCounty <br /> Earl Plmanlei Stocklon, California 95201 City of Escalon <br /> Fern Bugbea City of Mania" <br /> Daniel L. Flores 209/466781 City of Ripon <br /> John D. Mast, M.D. City of Stockton <br /> William J. Wade Jopl Khanna, M.D., M.P.H., District Health Officer City of Tracy <br /> Mary Anna Lova San Joaquin County <br /> 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 %yv/ s�ai drow -I <br /> C``G/` i <br /> hereby authorize �q/i�of/ '�, c'vrE�iiic ��p,,i/cS� 5Tt< rTo�� <br /> S' ;- <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 /> OwnJf Operator: AIA� Title: <br /> Address Phone: <br /> l S/' 9j- & CA 5r- <br /> Date: <br /> ENVIROMENTAL HEALTH <br /> FERMIT/SERVICES <br /> EH 08 OS UGT 13 e <br />