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eOAR0,01' IRUSIEES <br />,ismas Cultionson, P'es. <br />P.lfrcle E. Vannuccl, S.c'y <br />Anlhonolle Van SPionsen <br />Emil Plmenlel <br />F un Buot)ee <br />Daniel L. Flof@s <br />John O. Mai(. M.O. <br />William J. Wada <br />Mary /Anna Love <br />SAN JOQUIN LOCAL HEALTH 01STR10 <br />1601 East Hatchon Avcnue, P. O. BOK 2009 <br />Stockton, Callfornia 95201 <br />2W/466-6781 <br />Jog( Khanna. M.o.. M.P.N.. Olalrtcl Health O((Ica <br />SERVING <br />Cit yof Lodi <br />San Joaduln County <br />City Of Escalon <br />City of Manteca <br />city of Ripon <br />City of Stockton <br />City of Tracy <br />San Joaquin County <br />San Joaquin County <br />i <br />OR <br />AUTHORIZATION TO RELEASE ANALYTICAL RESULTS. GEOTECHNICAL DATA AND ENVIROMENTAL HEALTH <br />SITE ASSESSMENT INFORMATION FERMIT/SERVICES <br />I. the undersigned owner and/or operator of the property and/or facility <br />located at ko b 11 V, God f), -e � �z�' C- ZV 9, 4 <br />hereby authorize <br />;l .._ (I- (le ✓ ll <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: �. Ti tie: <br />Address /19V /V/,le ---T S Phone: <br />Ell 08 05 UG1 13 <br />;ZO„z <br />