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dOARo Of 1AUSIEES SAN JOAOUIN LOCAL HEALTH DISTRICT <br /> l.,n" Cultl.n,On, P'.,. SERVINO <br /> P.Mcl, E. v.nnuccl, Sac'y. City of Lodi <br /> Anihon.ft. van Spfon,an 1601 Easl Hatclton Avenue, P. O. Box 2009 San Joaquin County <br /> E.n Pfm,ntal Slockton, Callfofnia 95201 C41y of E,c,lon <br /> F.rn Supo,a City of M,ni,c, <br /> oanW L. Flora, 209/466-6781 City of Ripon <br /> John O. Most. M.O. City of Stockton <br /> William J. Wada Jopl Khanna, M.O., M.P.H., otalrict Health offlca, San Joaquin county <br /> of Ttacy <br /> Mary Anna Lova <br /> 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 property and/or facility <br /> located at I /�/ - <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 /> Owner/Operator: Title: J Ci'O,tiA/ Ik-eew <br /> Address U Phone: 0/K fL� -4- 4 <br /> Date: ��n <br /> I <br />