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1004,10"'1" <br />04,10Gf 1AUS1EES <br />1.ma. C.1bonaon, pfgj, <br />al,lcla E. VannWtcl, SOc•y <br />'It..ato van spfonaan <br />ail Ponanlal <br />am $up0aa <br />anfal L. Floras <br />ohn O. Mail. M.O. <br />1111an1 J. Wada <br />ary Anna Lova <br />SAN Ju OUIN LOCAL, HEALTH DISTRt , <br />1601 East Hazelton Avenua, P. 0. 6oK 2009 <br />Stockton. California 95201 <br />209/466-6781 <br />J091 Khanna. M.0„ M.p.K.. 0la11"10 Health Offltor <br />SEavlma <br />citr of Lodi <br />San Joaquin County <br />City of Eacalon <br />city of Manloca <br />Cltyof Ripon <br />Clly of Slocklon <br />Gtr of TraCV <br />San Joaquin County <br />San Joaquin County <br />AUTHORIZATION TO RELEASE ANALYTICAL. RESULTS. GEOTECHNICAL, DATA AND ENVIROMENTAL HEALTH <br />SITE ASSESSMENT INFORMATION FERMIT/SERVICES <br />I. the undersigned owner and/or ope <br />Located at <br />hereby authori zfi� <br />to release any and all analytical <br />assessment information to the San <br />res <br />tar of/�the property and/or -faci 1 i ty <br />.V. geotechnical_ data and site <br />n 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: Title: <br />Address Phone: <br />Dd <br />1 08 05 UGI 13 <br />