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bl,AkU w InUSIIts ;t6wA01-1IN l OCAL til ALIif UIWICT <br /> J.n rl Colbennon, P,ef. SI H':IhO <br /> P.riU. f VannuC[I, Secy City of Lodi <br /> Anlhonetle van Sptoneen 1601 East Hazetlon Avenue, P. O. Boz 2009 San Joaquin County <br /> City of Eacalon <br /> Earl Pimento[ Stockton, California 95201 City of Manleu <br /> Darn 209/466 781 City of Ripon <br /> L. Floret fl <br /> Daniell L. <br /> City Stockton <br /> C <br /> John D. Mail, M.D. City of Ty <br /> Wlftlam J. Wada Jopl Khanna, M.D., M.P.H., District Health Officer Sen Joaquin County <br /> Mary Anna Lore 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 Ecf�E✓> cora' ` o�<%. = '7S ^ /ii' OFraT B,,u(j �rr25�e-�a <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 /> Ownef/Operator: p_ / - Title: <br /> Address //J ,-ox ?mac" ;s'S rd Phone: 3� 3 - dig/ <br /> Date: <br /> EH 08 05 UGT 13 , <br />