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a o.Ro or tRusttcs SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> J•m., Cylt..n•On. P(a.. <br /> SERVINO <br /> P•1(IGI• E. V.nn..Ccl, S.C,y Clty of Lodl <br /> Anlhona/la Van Sp(ons.n 1601 East Nuelton Avenue, P. O. Boa 2009 San JoaOuln County <br /> La(I PI'nantal Slockton, California 95201 City Of E'Caton <br /> Fun Oopo*. City Of Maniac• <br /> Oanial L. Flo(es 209/466-6781 City of Ripon <br /> John 0. Mast. M.O. City 0(Stockton <br /> William J. Wade Jolll Khanna, M.O.. M.P.H.. 016trld Health 0((Icar Cllyol Tracy <br /> San Joaquin County <br /> Mary Anna Lova San Joaquin County <br /> DEC 3 lean <br /> ENVIHUIMENTAL HEALTH <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND PERMIT/SERVICES <br /> SITE ASSESSMENT INFORMATION <br /> 1 , the undersigned owner and/or operator of the property and/or facility <br /> located at TW 1 /1y" J iitNy ,(ppa�,,' Zyff � <br /> tr ` <br /> hereby authorize <br /> Lo release any and all an ytical 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: <br /> Address jy�/ Phone: , <br /> 03LC" <br /> ru nn ..r urr I ] _— <br />