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T <br /> y <br /> R <br /> 10 <br /> oAav ul inus, Pf SAN JOAQUIN LOCAL HEA1.TH DISTRICT <br /> J'emea Culasrtson, Pru SEAYINta <br /> lratrf la `Iannuecl, Sec'r Cily a€1001 <br /> An Ile van SOronfen 1601 East Hazelton Avenue,P o. aox 2L q San Joaquin County <br /> Eafff� ulp"r Stockton,California gWo1 City of Escalon <br /> - <br /> Fain Bupflss C4 Vol Manteca <br /> �snlat L. Floras 209/466-6781 City of FtI oca <br /> John D.mitst. M.D. city of shocitlon <br /> pon <br /> AZY 4 <br /> g MA 1,wave Japt Khanna. M.D.. M.P.H.. Ulslrlcl Hestln 0lflcar Cllyof Tracy <br /> �If+ry Anna tore San Joaquin County <br /> San Joaquin county <br /> lI <br /> E <br /> t <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, G£OTLCHNICAI. DATA AND <br /> I SITE ASSESSMENT INFORMATION <br /> I <br /> I, .the undersigned owner and/or operator of the Property and/or facility — <br /> located at 250 S. Main Street, Manteca, CA <br /> hereby authorize Canonie Environmental, Stockton, CA <br /> 1 �`p 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 /> i <br /> ,- <br /> Own er/Operat4�r: , � Title:AddressJ -- <br /> Phone: <br /> Date: <br /> i <br /> E <br /> EH 08 05 . i1Gr 13 <br />