Laserfiche WebLink
HUil Iii.:; J JOAOU111 LOCAL HEALTH DIS1'!ICT <br /> 5tHVING <br /> JimwG Cul(�Ison, Prda. City of Lod! <br /> Marr Anna Love, Vice Pre@. 1601 East Hazelton Avenue, P.O. Box 2009 San Joaquin County <br /> PNrlci• E. Vanouccl, Secy. San Joaquin County <br /> Tommy Joys* Stockton, Calllornla 95201 City of Eacalon <br /> Earl Plmentef <br /> Virginia Mathaws 209 466-6181 City t Manteca <br /> e City of Ripon <br /> Daniel L Fbree -- City of Stoekton <br /> John O.Mut,M.D. Jo9f Khannati M.D,M.P.H..Dirabict Haafth ofacar City of Tracy <br /> Gena S.Kraham 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 roperty and/or facility <br /> located at <br /> hereby authorize r <br /> to release any and all analytical results, geote hnical data and site <br /> assessment informat 'on 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 /> t <br /> Owner/Operator : � Title: <br /> Address Phone <br /> 5? <br /> ,c <br /> Date : <br /> EH 08 05 UGT 13 <br />