Laserfiche WebLink
aOAR o or SFlu s,ecs <br /> 1.m., DYlp.n.onPSAN AOUIN LOCAL HEALTH DISTRIGO <br /> ..,. - <br /> P•11I04 E. Vann..ccI, Secy_ SERVINo <br /> S <br /> Anthonalte van won,.n 1601 East Hazellon Avenue, P. 0. Box 2009 - - San Joe Clly-of lodt <br /> (all Plmental Quin County <br /> F..n suOnae Stockton. California 95201 - city of Eacafon <br /> Dan4f L. Flo... 209/166-6781 City 01Manteca <br /> John 0. Mari, M.D. - City of Ripon <br /> William J. Wada City of Stockton <br /> Jopl Khanna, M.D„ M.P.H„ District Health Officer CRY of Tracy <br /> MeryAnnaLor• San Joaquin County <br /> San Joaquin County <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> 1 <br /> I , the undersigned owner and/or operator of the property and/or facility <br /> located at '15-1 MOFpgT C3� ve. MgHS�xeq <br /> hereby authorize SCM CO <br /> to release any and all analytical results, geotechnical data and site <br /> assessfnent information to the San Joaquin Local Health District as soon <br /> as it is available and at the same time it is provided to the or my <br /> representative. <br /> �nH�gT CC�t..D �J TOt�A0.Vs C"O <br /> Owned/Operator: �� —� J <br /> _ Title: v � <br /> Address P.p 2,ox q�„ly Phone: S, <br /> 2-'4t, 3 � 8 � <br /> H 08 05 1161 13 <br />