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SAN'—)nUUIN LOCAL NEAL`T H 0151 t �,l scaVINO <br /> J•m,i c,,Iuenson. Pool. %wo, City of Lodi <br /> r;tticta E. Y,nnuccl• SaC'y. San Joaquin County <br /> /lntnonatta van Sp�onaan 1601 East Haletton avenue. P. O. Box 2009 <br /> City of Escaton <br /> rod Pomeftlet Stockton. California 95201 Ctty of mantaca <br /> ovt)oas 209/466 781 City of Ripon <br /> Cantu L Floes City of Stockton <br /> John 0. Mast. M.O. City of Tracy <br /> Wttttatim J. Wade Jopt Khanna, M.o.. M.P.H.. Ofatttd Health Otficar San Joaquin County <br /> t.tary Anna tow San Joaquin County <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS. GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> I <br /> I, the undersigned orwner and/orroperator of the property and/or facility <br /> located at _ /'�,�yc L,-;Pf e <br /> l��a ,c� / <br /> hereby authorize /' � ��j <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 avafiable and at the same time it is provided to me or my <br /> representative. <br /> OwnJ/Operator: L)L/ Title: <br /> ,Idress _ �, ,Cepa -�I-y _ Phone: <br /> Date: S= Y <br /> T <br /> EH 08 05 UGT 13 <br />