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JUAUUIN LOCAL HEALTH DISTRICT <br /> Orr SERVING <br /> r.Ma"L vrrwwc{ <br /> �rLemo.vwe,"`• 1601 Ead Haidton Av <br /> E 1«y. ttnue,P.O. Bot 2Gr, Clry of t.odl <br /> T�n�w7 Jww Ilio io&q m C"'ty <br /> !.� Stockton,Glllomis 95201 San Jo'gWn Cwnq, <br /> KVkk Mav. CM of E.cNon <br /> p—W L Fsor,M (209) 166-6711 Cky a Manteca <br /> Cky <br /> mpan <br /> Jaw 0.MµMA Jop110�n"^ti Mdr MJ'JI„t1MrIo1 Noyes Ofur _11y a aStockton <br /> Gone IL Iueh" <br /> C*y <br /> �r son Q,aa„ce ' <br /> nty <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> i , the undersigned owner and/ot• operator of the property and/or facility <br /> `- located at <br /> _ .. : C_e_c:-.:ee roc_._ P,ae Foci Calif. – krco 'acility t'760 <br /> hereby authorize <br /> to release any and al ! anLlytic:il 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 /> i0 Owner/Operator: <br /> Address Title : <br /> ---Phone : <br /> Date : <br /> NOTF: <br /> This form to be completed and signed upon <br /> commencement of excavation. <br /> TOM MEMINGER CONSTRUCTION, INC. <br /> Ell 08 05 UGT 13 <br /> 7 . . <br />