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6n 0' Pnusrt:Es SAN JOAQUIN LOCAL HEAL TH DISTRICT <br /> a Cuiberlson Pray SERVING1 <br /> i Vannuccl SaC y Clty of Lodi <br /> !h a Van Spron3an 1601 Earl Ha2eltor. Avenuo, P O Box 1W) San Joaquin County <br /> TIMenlel City of F_scalon <br /> Slockton, California 9,):Ot City of Manteca <br /> Xr ug0e+ <br /> n pl L Flores 209/466-6781 Uly of Rtpon <br /> hn 0 hlmst, M 0 C11yof Stockton <br />!�m j Wada .foga Khanna, M D , M P H., (11strlct Haelih off$(or n City of Tracy <br /> trine Love San Joaquin County <br /> San Joaquin County <br /> t <br /> UTHORIZATION TO RE[ FASE ANALYTIC AI RFSO( lS , C,EOTFUNIC►AI f)ATA AN17 <br /> ITE ASSESSMENT INFORMATION <br /> I , the undersigned owner and/or operator of the property and/or facility <br /> tcated at 1876 Country Club Blvd. , Stockton, CA <br /> reby authorize Canonie Environmental , Stockton, CA <br /> l*elease any and all analytical results , geotechnical data and site <br /> ssesSfnent information to the San Joaquin Local Health District as soon <br /> lS it is available and at the same time it is provided to me- or my <br /> epresentati ve. <br /> r <br /> ^ a <br /> r <br /> Lner/Operator: Title, <br /> Addre-s �� <br /> -t- ' ''. .� Phone• .C- C ' <br /> ate: <br /> i <br /> 6 <br /> it nn nr, I tf:T a <br />