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a;eno Of IRu trs SAN JOAQUIN LOCAL HEALTH DISI I ;;CT <br /> SERVING <br /> 'lame%-Culbeneon, Pru. _ <br /> ►elllcla E. vannu cl, SaC'y. - City of Lodi <br /> Anlnonella Van Sprod1uv 1601 East Hazelton Avenue;,P.-0. Bole 20V San Joaquin County. <br /> [of I rimanlal - - Stockton, Call lomia 95201 - - - City of E.c.lon, <br /> Fern Bupoae - - _ - City of Manteca <br /> Daniel L. Floss 209/466-6781 - City of Ripon <br /> John 0. Mast, M.O. - f'(G�3 1�� - GAY Of Stockton <br /> City of Tucy <br /> William J. Weds Jopl Khanna, M.O.,M.P.M., DisfAct Health Oflicaf _ San Joaquin County <br /> Mary Anna Love 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 ice ,I.� <br /> T C -pO �I !� S1—ese /�� <br /> hereby authorize .SPS (--o <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 /> Owne�/Operator: Title: <br /> Address Icy Itjpx ; s Phone: <br /> mown k:eC cc <br /> it 06 os ow 13 , <br />