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uOARV Or 1664 6 cc, <br />jam Culbatison. Pros <br />cis "- <br />P1toE. vannuccl. zoc'y. <br />Artihonette van Spronsen <br />Earl Pimentai <br />Fern Bupbee <br />Daniel L. Floras <br />John D: Mast. M.D. <br />Wlillam'J. Wade <br />Mary Anna Love <br />1601 EHazelton Avenue, P. D. Box 2009 <br />aJ <br />Slockton, Callfornia 952011 <br />209/466-6781 <br />Jogl Khanna, M.D.. M.P.H., Dlatrict Health Officer <br />AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br />SITE ASSESSMENT INFORMATION <br />Clty of Lodi <br />San Joaquin County <br />City of Escalon <br />City of Mantoca <br />City of Ripon <br />City of Stockton <br />City of Tracy <br />San Joaquin County <br />San Joaquin County <br />71][100 <br />ard <br />I, the undersigned owner and/or operator of the property and/or facility <br />located at �j �'� l v i U �-- .� ►� r� � -1 r C.. 79� <br />hereby authorize (1'�,ti� i'C C�i� Ir L�cL <br />to release any and all analytical results, geotechnical data and site <br />dssessment 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 />Owne�/O erator4 C—e. <br />Phon., <br />Address 4,- <br />Oa <br />A <br />EH 08 O5 UGT 13 P <br />