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SOAR41tiSTFIES JOAQUIN LOCAL HEALTH DISTRICT <br /> seayiHc <br /> J.m«Cu1Wrlaon,Praa. <br /> City d Lodi <br /> Mary Anna Low,vka►r«. 1601 East Hatatton Avenue. P.O. BoK 2009 San Joaquin Counly <br /> ►.Irina E.vaonwcl,6at'y. San JoaquM County <br /> Tommy Joyca Stockton, California 95201 <br /> E.A►knenlal City of Eat Non <br /> Viegir a Man @ws (209) 166-6701 Chy of Manteca <br /> Der"L fbraa City of RIP on <br /> John O.Maatr M.D. Joai Klwrnti M.D,M.►JI,D WMd HaNN Ofacet Otty of Stockton <br /> Cky of Tracy <br /> Dana 0.KraAam 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 14W Z. iAyd,, ✓ yoR <br /> hereby authorize 4,.,t <br /> to release any and all analyt cal results, geotechnical data and site <br /> assessment information to the San Joaquin Local I{ealth 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. - �- j <br /> /Y/.4�Address -Edd �rJ P - �fb�' Rhone: �� 47- /09D <br /> RU OVA PC- <br /> Date : <br /> LDate : <br /> FNV1R0\4twlhL HLALTH <br /> 1 M?MIT/SERVICES <br /> EH 08 05 UGT 13 <br />