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mu ur tnusrEEc <br /> J•"a Cufowtaon, SA4OUIN LOCAL HEALTH DIST <br /> Praa, "� <br /> f arrac4 E. vannuoct, S.c'y. SERYmo <br /> AnlhcvWfa van Sf•ronaan 1601 East Hazelton Avenue, P. O. Box 2009 San JoaquinGly of Loci <br /> Ew mmentdcounty <br /> Fwa Bupbaa Stockton, California 95201 City Of Eaoalon <br /> D&AW L Floras 209/4%-$781 city of Maniacs <br /> John 0. Mast, M.D. City of Ripon <br /> Witham J. W"o Gly of Stockton <br /> MwY Anna Low Jog' Xhan'u< M-0, M.P.H.. District Ifaslth Offkw Gly of Tracy <br /> San Joaquin County <br /> San Joaquin County <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> I, the undersignc� ncr 80d/or operator of the <br /> located at �� Property and/or facility <br /> hereby authorize <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�;Oper4jtor: <br /> Address /I �F F �1 -) <br /> Title: <br /> Phone: •S !�S <br /> Date: , <br /> - � - <br /> EH 08 05 UGT 13 <br />