Laserfiche WebLink
�J.n•.r (.r,iL.,inm, 11.., -� '- „ . i II nl i I n.. i I�1. 1 <br /> odlbUi ( ail H--kll <br /> ieon 7\v Cllr nl l <br /> �ilhOnall• Van $pron fen 1 - l'(l ll0, 1a, �. Hnl �( � `+.n JOaq <br /> E auln <br /> COvnly.0Plm and el <br /> Slocklon, Calllornia 95201 city of Eac.ton <br /> Fun Dup Ds• City of Manteca <br /> Oanlel L. Floret 209/466-6781 City of Ripon <br /> John 0. Ma,l. M . City of '10 1M1on <br /> William J. W.de Jog[ Khanna. M.D., M.P.H.. Olalrlcl Health officer City of Tracy <br /> Mary Anna Lova San Joaquin County <br /> S.n Joaquin County <br /> ou"kacL/LOCVCbWr Cm <br /> Q lL`,t7 L. <br /> t(:p4i 9 CA-- <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> I , the undersignedoa /ems-a?eFaEet` of the property and/or facility <br /> located at _ la-ap C Vic:T(or jZoakj Lo f i c <br /> hereby authorize L,/ j pjN PLj8c�r q� /-SSOC,a <br /> to release any and all analytical results, geotechnical data and site <br /> assessment information to the San Joaquin Local Health District as soon <br /> as it is available and at the same time it is provided to me or my <br /> representative. <br /> Ownewp"*ter: lted E(t Title: A �� <br /> Address �` <br /> r L L Phone: 21y - a33 —f�6// <br /> P22 Lt3.TFred c acv sago <br /> Date: <br /> 'DA IWS, Tq*&< 5 —gY�y6 <br /> a <br /> EH 08 05 UGT 13 8. <br /> 3,4vfly <br />