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ARO Of ]Ault(($ <br />m.t Cutb.n.on, Pt.,, <br />,,Oct. E. V.nnuccl, S•c'y. <br />Inonelte Von Sptom.n <br />�1 Plm.nlel <br />�n eup O.e <br />nlef L. Flot.. <br />n 0. most. M.O. <br />Il.m J. Wed* <br />ry Ann. Love <br />SAN,I8AQUIN LOCAL HEALTH DISTRl� <br />1601 East HAJellon Avenue, P. O. Bott 2009 <br />Stockton, CalNornia 95201 <br />209/466-6701 <br />Jopl Memo. M,Oy ilf^jf. Otelacif Health Officer <br />SERvima <br />Gtr of Lodi <br />San Joaquin counly <br />GIY of E&colon <br />City of maniac, <br />Gly of Ripon <br />Gir of Slocklon <br />Gly of Teacy, <br />Sen JoeQuln County <br />San Joaputn County <br />AUTHORIZATION i0 RELEASE ANALYTICAL RESULTS GEOTECHNICAL DATA AND ENVIROMENTAL HEALTH <br />SITE ASSESSMENT INFORMATION FERMIT/SERVICES <br />1, the undersigned owner and/or operator ofhe property and/or facility <br />located at / ;!24 1 1.-- �. If <br />iereby authorize <br />:o release any and all analytical resu geotechnical data and site. <br />%sessme-k infortm tion to the San Joaa in Local Health District as soon <br />�s it is available and at the same time it is provided to me or my <br />•epresentative. <br />wne�/Operator- <br />//l <br />Title: <br />ddressl% Phone: <br />a <br />