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0 <br />0OAH0 Of IMUS11 L14 SAN JOAQUIN LOCAL NIEALl Ii f.)IST)iICT <br />'.f {{VlNll <br />Jamea Cult3enac)n, Prna. <br />PalflCla I V,rnnuccl. 5er_'y r tally u! l nr11 <br />Anlhonelte Vari Swonsen 1601 EraSt H17ellon Avenu©, P. 0 flax 2(X)9 San Jnaquln ('nunry <br />Larl f'Imnninl City of Facalon <br />Fern <br />Stockton, Calllc�rnia 95201 c+► yy �'( Ily of Manlnrr, <br />Dugt�ob \"� Clly+rI filpun <br />Daniel L. Flores 2{}9l4fiti-67$t 1� j IS of `ilncklr n <br />John D. Most, M.D, llr,r Y <br />`r► <br />City of Ifelcy <br />W11(lam J. Weds Jogl Khenne, M.D.. M.P.H.. ofeirlct HAMM Of ,,)c ,"'San Joaquin (,minly <br />Mary Anne Love 'ti San joaqulr, r;+,,,nly <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 (' Ai I i o\ -,- f- L a /C <br />hereby authorize j�%,� Ilh\ I � I -),f1--,-7.) 11—.4L <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 />0,,ner/Operator• Ti t A4,0a' o GX <br />AddressA70, Phone: % d <br />D,Ite: CJ 9 <br />I <br />CH ns nc, <br />