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1 . f <br />Anlhonelle Von Spronsen <br />Errs Plmanlet <br />Fern Bugbee <br />Daniel L. Flores <br />John D. Mast. M.D. <br />William J. Wade <br />Mary Anna Love <br />*a, <br />Aycf,tjo, J' U_ 13ax ?t}i„hf <br />Stockton. Callfornia 95201 <br />209/466-6781 <br />Jogl Khanna, M.D., M.P.H., District health Officer <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 /U,- 6 ry rp ` <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 />O rn6/Operator: �'�� yg c; Title: <br />Address t Phone: <br />Date: <br />€H 08 OS UGT 13 <br />Cllr of I oai <br />'6n JOAquln Counly <br />City Of Escaion <br />City Of Manteca <br />City of Ripon <br />City of Stockton <br />City of Tracy <br />Sen Joaquin County <br />San Joaquin County <br />