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" i <br /> _. < . �< . _ <br /> Jareoe,AD OF 1auSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> Jamas Culbertson, Pros. <br /> Palffcla E. vannuccl,Sac'y Clly of Lodi <br /> Anfh ette van Spronson 1601 East liazellor•Avenue, P.O. Bax 2009 San Joaquin County <br /> C'y of Escalon <br /> Earente' Stockton,Cctliornia 95201 Cllyof Menleca <br /> Farn,ougoaa Ctt of pl <br /> Daniel L. Floras 209/466-6781 City of Stockton <br /> POA <br /> John D. Mast. M.D. C11yof Tracy <br /> Wffflam J.Wade Jool Khanna, MA.M.P.M., District Health Offlcar San Joaquin County <br /> Mary 4nna Lore San Joaquin County <br /> i <br /> I <br /> s <br /> i <br /> i <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> { <br /> I., the undersigned owner and/or operator of the property andior facility <br /> located at 260 E. Main Street, Manteca, CA <br /> a hereby authorize Canonie Environmental, Stockton, CA 983-1340 . <br /> to release any and all analytical results, .geotechnical data and' site <br /> ! <br /> Isessment inforfnation 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 /> 3 <br /> Ownet'TOperator. ' Title: Owner L-IA-- <br /> n <br /> Address Phone: (alb SR6-05;9 ' <br /> San Francisco, CA 94134 <br /> 3.' <br /> M <br /> Date- �/ <br /> IFr <br /> A ! <br /> a i <br /> p : <br /> ;6 F <br /> Y �...AD nr IirT .tZ <br />