Laserfiche WebLink
QAxA Of InusfEcs SANWAOUIN LOCAL HEAT. TH 01STOT <br /> ' <br /> 11Fzla E. Vannuccl, S.C'y SCRVINO <br /> n1honme van Spron,en 1601 East Hatellon Avenue, P. O. B0K 7009 91y of todl <br /> ` "! rimenlai SanJDaaulnCounty <br /> rn sugora Slockton. California 95201 city OfE,calon <br /> n1al L. Floras 209/466-6781 City of Manlace <br /> nn 0. Ma,l, M.O. Clly of Rlpon <br /> Illam J. W■rii Cfty of Slockton <br /> Jopl Khanna, M,p„ M.P.H.. ofafrfef �laalth officer Cllr of Tracy <br /> ry Unna ldr. San Joaquin 0 County <br /> S■n Joa©uln County <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> S"f[ ASSESSMENT INFORMATION <br /> 1 . the undersigned owner and/or operator of the property and/or facility <br /> located at 21-03 F_—_ 2A 0,O C4 . z"Zc� <br /> hereby authorize �?� � ,�� —�—� <br /> to release any and all analytical results. geotechnical data and site <br /> assessment information to the San Joaquin Local Heath District as Soon <br /> Is it is available and at the same time it is provided to me or my <br /> -epresentati ve. <br /> �-mef-/Opera to r: /' f <br /> 4 Title: <br /> ddress .12 Phone: <br /> '`� - <br />