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60nRO Or •IRVSI(ES <br />l.mu.��Wan $on, ria$. <br />Panel. (, V.nn�ccl. S.c'r <br />Anlhonella Van Sp...... <br />(..I Pl.nlnl.l <br />Fun Oup Oa• <br />Oanlal L. Floras <br />John 0. Mal(, M.O, <br />William J. Wada <br />Mary Anna Lova <br />• f <br />SAN JOAOUIN LOCAL HEALTH DISTRICT <br />SERVING <br />1601 Easl fia-rellon Avenue. P. 0. Doc 2009 Santill' of LOCI <br />JOa Qu In COunly <br />Slocklon, Callto(nia 95201 city of E$talon <br />209/166-6781 city O( Mani .1. <br />CI(y of Ripon <br />CI(y O(Stock(on <br />Jopl Khanna, M.o., M.P.N., District Naal(h 0(flcer City of Tracy <br />San Joaquin County <br />San Joaquin County <br />AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECN,NICAL DATA AND <br />SITE ASSESSMENT INFORMATION <br />I. the undersigned owner and/or operator of the property and/or facility <br />located at 11 r1 A . . r` _ A <br />hereby authorize ( d4(F�l�A(a4 �� 1A <br />/5 T�1� &L f2 <br />Lo 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 />Owner/Operator: cM <br />Phe <br />Phone Address (�a t3OIAx <br />Phone <br />l�io�d� C A g53S-� <br />Oa LC: _3/27 <br />C D1 C. <br />��/5Z1-390 <br />