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tlOAno or 11 AUSI -ES ' <br /> aA _ JQA( ()IN 6CAL HEALTH DISI CT SERVING <br /> Jorios Culborl5on, Prov, <br /> Pelricla E. Vannuccl, Soc'y. City of Lodi <br /> Aa Ihonotta van Spronson 1601 East Hazelton Ayenue, P. O. Box 2009 San Joaquln County <br /> Eorl Pirnontol Stockton, GaUlornia 95201 City of Escalon <br /> Forn E3upbs13 City O4 mantoca <br /> Oaniof L. Floros 201/466-6761 City of Ripon <br /> City of Stockton <br /> John D. Mast, M.D. Cfty of Tracy <br /> William J. Iad® Jopl Khanna, l�i,[A. 8,3,E 6 J., Qiatricl Honith Officer San Jonquin County <br /> P.4 asry Anna Lava San Joaquin County y <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> I , the undersigned owner and/or operatorr of the property and/or facility <br /> located at _193 <br /> hereby authorize <br /> to release any and all analytical results, geotechnical data and site <br /> assessment information to the Sart 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 /> Owner/Operator: Title: <br /> Address Phone: <br /> Date: <br /> FH 08 05 UGT 13 <br />