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l .,ai 11.u6rw,r..r4l,uif, r u „�., <br /> DATE: �. <br /> Stockton, Calilorn+a 95201 <br /> rlortlt <br /> 209/466-6781 SAH -to <br /> • .,t, µ D 1 501 I� Gv J� s•N�ve y ��..P <br /> . VY • Jog[ Khonn., M D-, M P H., Distrld Ilt:.l P <br />•ry Ann. Love <br /> aO <br /> NAME_ RE <br /> I ADDRI M <br /> APPR( <br /> DATIOC04207 C 71 -P� <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS. GEOTECHNI Apprr �p �A � <br /> ahowr <br /> SITE ASSESSMENT INFORMATION appy, ' <br /> Stat <br /> I , the undersigned owner and/or operator of the proper 1 , <br /> � l3 M p. <br /> located atLqO- <br /> hereby <br /> authorize Arl elcC <br /> to release any and all analyte a °results. geotechnica z1 o San Joaquin Local lae10M District <br /> 4ssessment information to the San Joaquin Local Health 2 . INTER OFFICE6/85 <br /> :Asenta <br /> it available and at the same time it is provided ADM0103 <br /> Live. ( C` 3 . <br /> Owner Operator: /I/J���/�1�`. / //� i.-- Ti tl <br /> Address /fin Phos <br /> Date: 7 <br /> h <br /> 4 . ni, <br /> • S . <br /> E 1t 08 05. UGT 13 <br />