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J ,=l �AMJJ-U 7A(�$y 8 TAT 1 = 5 r-1uC1RE RETROL- L -o r-1 <br /> At crow,Pi OR, bmN JOAOUIN LOCAL HEALTH DISTRICT F <br /> Farr Ptmantal,Vir,.a Prot, SERVING <br /> TOMMYJoyca.may. 1601 East Hazelton Avenue <br /> James F.Cul- Stockton, Calllornia 95205 Sin Joaquin County <br /> v&4,o, �Iry W Manteco <br /> John b,Moat.M,o. <br /> Vrginra Mable',-* JOG) KHANNA, U,t)., M.P.H., DISTRICT HEALTH OFFICER Erj O'rY or EmcafRn <br /> Phomas$,h,ha, Clty of Loa;, <br /> t rt D City of rrocy <br /> Daphne Shaw City of Aipon a <br /> f4g"Y:;'Ifliar,1. Ph a, Sr rJcsquin County <br /> 04Y o1&Ockton <br /> San Jnhquln County <br /> 1: <br /> AUTHORIZATION TO RE):,EASR ANALYTICAL � <br /> 131:SUI,TS, 6EOTEC1iNICAI, DATA AND <br /> SITE ASSESSKRNT 'NFORMA,T ION <br /> I , thq ut�clai•sigr�ed owner and/or ok"vva �� o <br /> f the property And <br /> vacated at l � y � �"" �f/i mil y /or i`6r:� lity <br /> hereby AUthorize d _. -G ' <br /> to release tiny and all analytical results , cote <br /> chnical data And s'.lto <br /> assessment in ormatian tO the Shr, Joaquin Local 1'fealt1l Uis . <br /> as it is available and at thcj same time it is trio as soon <br /> representative , provided to me or my <br /> 1 <br /> Ownar/dpei,ator: <br /> Address; <br /> Phone V <br /> Date. <br /> t <br /> tH 23 041. 3/86 <br /> JU <br /> Adm1Wvt.,nt»n CIInlcal sery1coo <br /> 4�•�D0 Envitonmantal tiemth <br /> r _ 46B•3A3q i<�-3426 Pub"C HBQt+>^,Nut9i Ip <br /> Alt f'ollutlon Cammuniry co�3ervly--- 4fti•3A60 <br /> 4U-3470 Laboratory <br /> 488-9820 468.3460 WIG <br />