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I lig, <br /> esaAno or eausrtr s ,,AN JOAOUIN LOCAL HEALTH DISTRICT <br /> Jaaga C+�banwav,PrN. <br /> SERy;NG <br /> Obey A—L,".Vka prod. 1601 Eac:H01011an Avonuo.P.Q.Box 2009 C4 o(kodi <br /> � <br /> Psukw L YtrO^ ',R&".Y• Un ieaqt04 C—t1 <br /> isffimp.4r-a SWIxIon.CaulornlaIs t UnJaWuwCmomY <br /> 4!84 vWWMafCKY 01 <br /> VirfWaraarnawa (IOQ)468•8181 <br /> DonW L Fiona r of cltpMlAFanlalCof��a <br /> John o.aWaaL M.O. laq xt w e.or.P1t,ow tor.�.. a r e1 atadd" <br /> t as"a.Ka.nam city W react' <br />` k <br /> r <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS. GEOTECIINICAL DATA ANO <br /> SITE ASSESSMENT INFORMATION <br /> I, the undersigned owner and/or operator of hero <br /> pert <br /> P P and/or facilit <br /> located at ^l LcJ. / � /ti - ' r 7� f <br /> t hereby Authorize + <br /> to release `any and all analytical results. <br /> geotechnical data and site: <br /> assessment information to the San JuagrAin Local lie <br /> alth District as soars E <br /> as it. is &vailable and at the same time it is pravided to me or my <br /> i; representative. �} <br /> Owncr/Upera[or: r Q^e.zJDt <br /> Title: <br /> Addres �La�o7 '• ' _ <br /> e. <br /> Date: /a � <br /> EH 08 05 UGT 13 <br /> �"! <br />