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r• , <br />Maly Anna lora, Vka Pr« <br />PatrlCla E. Vannuccl, SK•,. <br />To.nmy Joyc• <br />Ean Plmante/ <br />Virginia Mat .,,, <br />Danlai L Fioraa <br />John D. Maat, M.D. <br />Gana S. Kraham <br />•�;kt" Jo "Ui14 LOC ,L HEALTH <br />UISTFZICT <br />1601 East fiaietton Avenue, P.O. Box 2009 <br />Stockton, California 95201 <br />(209) 466-6 76 1 <br />Jogl Khanna, M.O., M.P.H_, Diatrky Haam mar _ <br />AUTfiORIZATION TO RELEASE ANALYTICAL RESULTS <br />SITE GEOTECHNICAL DATA AND <br />ASSESShfENT INFORMATION <br />SLRVING <br />City of Lool <br />San Joaquin County <br />San Joaquin County <br />Chy of Eacalon <br />City of Manteca <br />City of Ripon <br />City of Stockton <br />Chy of Tracy <br />San Joaquin County <br />I. the undersigned ownerd/or operator of the property <br />�% o'f1C/�C p Y and/or facility <br />located at <br />hereby authorize r- <br />to release any <br />Y and all analytical results, <br />assessment geotechnical data and <br />information to the San Joaquinsite <br />as it is available Local Ifealth U' <br />and at the same District as soon <br />representative. time it is provided to me or my <br />Owner/Operator: <br />Address _-- Title: <br />--__ Phone: <br />EH 08 05 UGT 13 <br />��j <br />