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`oano or iRuslles SAN JOAQUIN LOCAL HEALTH'DISTRICT <br /> Jomma Culbenaon, P,aa. SLRVINO <br /> PaI,I[le E. VannuCcl, SaC`y. " Clly otlodl <br /> Anlhoneue Ven Spron sen 1601 East Hazel ton AY•�nue, P. 0. Box 2009 - Sen Joaquln County <br /> Earl Ptmenlal Stockton, California 95201 City of E3calos <br /> Fern 6upoee City of Manteca <br /> Dania[ L. Flores 209/466-6781 City of Ripon <br /> John 0. Mast, M.O. City of Stockton <br /> William J. Weds Jot Khanna, M.D. City of Tracy y <br /> 0 M.P.H., Olelrlct Health OPllcer <br /> Mary Anna Lova Sen Joaquin County <br /> ` San Joaquln County <br /> 110�0 <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> 1 , the undersigned owner and/or operator of the property and/or facility <br /> located at1977 / i._ ,� 1 7 <br /> hereby authorize <br /> to release any and all analytical results, geotechnical data and site <br /> dssessment infonnation to the San Joaquin Locdl Health District as soon <br /> as it is available and at the same time it is provided to me or my <br /> representative- <br /> Owned/Operator: � n --iTcie: t / <br /> Address _1_���3 .g� Z� Phone: 1� ^ 1�l <br /> Date: <br /> DEC 7. rvc a <br /> ENVIROME. TAI kl LTM <br /> FERNIII/JE.m , a <br /> EH 08 05 UGT 13 r <br />