Laserfiche WebLink
SAN JOAQUIN LOCAL Fi ALTH DISTRICT SE71VtNU <br /> 1; A+f1a OF THuSTEES Cllrol LOdI <br /> h, zaa Cuinanaan, Pray San Jaaquln County <br /> .-+a E. vannuccl, sac'r 1601 East Fialelton Avenue, P O, Box 200 City of Earalon <br /> Ai affa vary SplanlonCity of Mantaca <br /> "c°i t?lmantal Stockton,California 95701 <br /> Clly of Filvon <br /> n fiut7b� 2091466-6781 CRY or Stockton <br /> Nkniei L. Flares City of Tracy <br /> loth-D. 161931,M.O. Son Joaquin CounlY <br /> Jogl Khanna, M.O.,M.P.H., [3levlct Haalln Uiftcar <br /> N arts J.Wada San Joaquin County <br /> A y Anna Lora <br /> ,,.AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, 6E:GTEQIWCA1. DATA AND <br /> , ;SITE ASSESSMENT INFORMATION <br /> I, the undersig^.ed owner and/or operator of the property and/or facilitY <br /> '"located at 260 S. Main Street, Manteca, CA _ <br /> ' <br /> hereby authorize Canonie Environmental , Stockton, CA <br /> release any and all ana?.,tical results, geotechnical data and site ,t <br /> assessment information to the San Joaquin Local Health District as soon <br /> it is available and at the same time it is provided to me or my <br /> ,..,.representative. <br /> l� �° r[� Title: <br /> Owner/Operator: <br /> i✓ ,� j Phone: !�1 � <br /> Address ` <br /> ' � to ` <br /> Date: <br /> EN 08 05 UGT 13 <br />