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■OAgO pf IRUittts SAN J(jAOU.IN LOCAL HEALTH pISTAI <br /> l.m,r Culbenton.. t'ret. <br /> P.ir iii, E. v.nn acct, Secy - <br /> SEAviHo <br /> Anlhonert• Van Spron,en 1601 Easl Ha.2ellon Avenuo. P. O. Box 2009 S,nCliyol Lodi <br /> ,..$I Pimenlal - �O�Qu1nCOunty <br /> *in bvpUe• <br /> Slotkion, Callfo�nia 95201 CityofE,c.Ion <br /> 2W/4666781 City of Manioc. <br /> ),nlel L. Rorer 2W/466-6781 <br /> ohn 0. M,sl, M.O. City of RlponCllyofSloCkton <br /> Wad <br /> (ory A J. Ldve Jopl Khanna, M.OyM.P.H OI■Irld Health Offic.r Ci■y of Tracy <br /> 1•ry Anne Low S■n Joaquin County <br /> San JoaQuln County <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> I the undersigned owner and/or operator of the property and/or facility <br /> located at <br /> hereby authorize /v <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 /> ONne�/Operator: ,J Title: <br /> AddressC-? Phone: <br /> Oa cc: <br /> i <br /> k <br />