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AA14 JUhUWi% LUl:AL HtAL l H UI` `111,1 SEA1(ING <br /> M"A^41*4 lave.fte►c... ~"' 1601 Ear!Nacefto�l Avanua.P.O.80K2009 <br /> Cir4L-d1 <br /> ►a1r1N.E.v.mwcc�a.c�r. <br /> StOMON caufaiwe 9S201 "ta'I�+Quhi Cw�r <br /> E•A►bwMl�i <br /> �Gylr�f'E.iedo� <br /> (2021464-4711 MMIKa <br /> 04#."L Ma <br /> J,$�A a Mae%MA. ck,d V4.0" ^ <br /> 0.�.L Kr-ham a•vi x+�M.o.re.►.N..oaNa�t..hn o«k« ah.c TCacr <br /> AUTHORIZATION TO RELEASE ANALY'T'ICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> 1 <br /> i . the undersigned owner and/or operator of the property and/or facility <br /> located at Pc, y,,I <br /> hereby authrorize _ ,d.�.,��:,� �- �� ,; <br /> to release any, and all analytical results, geotechnical dati and site: <br /> assessment information to the San Joaquin Local Health District as soon' <br /> �r <br /> as it is available and at the same time it is provided to me or my <br /> representative. <br /> OwncrfUperato Ti t li : / <br /> Address Phone: <br /> t D a t e : <br /> t <br /> 1 <br /> 1 <br /> L <br /> EH 08 05 UGT 13 <br /> ... �"L!:• IM:i1�'.'�i�.M�-. u-:.=. J•..'.4N.' u/•,{lY��:RI/..R� ..tLf!'.^•• - .i:i/f•�< `'.,'Y. : �1�-^-7"„PR'.�'N�'�+'.S�.r��.Y. <br />