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PRom 07-/ 15.88 09153 P. a <br /> 10A► ply tilo",'Fri SAN JOAQUIN LOCAL HEALTH I)ISTRIOT 51AVI 1p <br /> tilam"si Cutb�H/on, f°na, <br /> Patrlcla G. Vannuool, 8a0'y. 011y Of Lodl <br /> Anthonvtte Van Bpromogn 1801 East HaWton Avanue, P. O. Box 200 Ban Joaquin County <br /> l;srl p1monisl Stockton, Cailfornla 05201 alyof Wsp#lon <br /> Fern Avabee city of Msntsos <br /> Daniel L. Flofts 2091488.8781 01ty of m1pon <br /> John D. Malt, M,t), 011yofstooklon <br /> William J, Wide Jogl Khanna, M.1)., M,P.H., 01str14l Hss11h Of1100r 01ty of T►aoy <br /> Mary Anna Lova bin Joaquin county <br /> Min Joequln County <br /> AUTHORIZATION TO RELEASE: ANALYTICAL RESULTst 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 /> horeby authorize <br /> to release any and all analytical results <br /> Y , geotechnical data and site <br /> assessment infol,iration to the San Joaquin Local Health District es soon <br /> es it is available and at the same time it is provided to me or my <br /> representative. <br /> Owner/OperAtor: <br /> -�--.-•,.-- --- - - Title <br /> Address — 0/ � 1:1_a.,,- ,Phone: ( 3 <br /> bate. <br /> rH 08 05 <br />