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� ter• � �� w . �:�s � <br /> TnUSTEES �SAI4 JOAQUIN LOCAL HEALTH )STIUCT s€nvitic <br /> r�1400,rrr.. Off of,.L*".ow,v►ca rr... 1601 Eae!Hole ton Avenue. P.O.Box 20lode <br /> 9? s.n Jeoq�in of Lo r <br /> L Y.�+rweel,t+c'r. 3.n Jwgvin county <br /> •y Joyce Stockton,CAIIfornk 95201 Chy 44 CK,Ion <br /> lr4n«,i.f Uy of M.nlac• <br /> aldms*". (209) 4r0.6781 cltye(WPO., <br /> 1.1 L fb.« City d StocAt" <br /> J.Iw D.MwA.M.D. J.y!Kh.Mr�H,D.1l,r,ll^vio i 111..rh Or+c« Cry of Tr►cf <br /> d.n Je.q..ln Cd+nrr <br /> E' <br /> F <br /> AUTHORIZATION TO RELEASE ANALYTICAL. RF,SULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> 1, the underaigned owner And/or operator of the property and/or facility <br /> located at <br /> 4ereby AuthorizeTA <br /> to release any Rnd all analytical results, geotechnical data and site <br /> assessment information to the San Joaquin Local Health District les soon <br /> As 1.t is available and at the same time it is-provided to me ori my <br /> representative. <br /> 0`"nCrfUperator: � Title: <br /> AddreNs <br /> S hone: Itur"I1 <br /> Date: <br /> h <br /> i <br /> ri f <br /> IV <br /> ) lr': 114Ti¢i!1 t$�Itti r' 11lS 1 r�y{idfr� j <br />