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r,uaRc W IIIUSILt s SA*AOUIN LOCAL HEALI H [)IS1 41,1 <br /> Sf RVING <br /> Junes Cui;re Aeon, Pine <br /> Pamcle E Vann,,Ccl. Snc'y City of Lodi <br /> Anihonelte Van Spronsen 1601 Cast Hazelton Ayenuo, P. 0. Box 2(X19 Sen Joaquin County <br /> Earl Plmentel Slocklon, California 95201 City of Escelon <br /> Fern Bupoae <br /> City of Maniacs <br /> Daniel L. Flores 209/466-6781 City of Ripon <br /> John D. Mast, M.D. City of Stockton <br /> City of Tracy <br /> William J. Wade Jog[ Khanna, M.D., M.P.H., District Health Otflcer San Joaquin County <br /> Mary Anna Love Sen 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 l2S r._u CG_ , <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 /> Ownef/Operator: 12 cri Z <br /> �,y. Title: <br /> Address / 7�5yj�j��L�,, L�iG�• , ._�n� �j��3 7� Phone: <br /> Date: <br /> a <br /> EH 08 05 UGT 13 <br />