Laserfiche WebLink
6 t�..�.#y�- � � s.j„y n .� �arP r�-. '' :e`:�:'" •-+Sw��'�'"'""tt }k �' sS ;i}a � ;y "J�" .L- <br /> t�T <br /> x, <br /> s>=avtHa <br /> City of Lodi <br /> __.<.AA-71-LMST t`IIGT utn Counsy <br /> ~acaion <br /> D. <br /> `J <br /> aoARD of TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> James Cufbarloon, Pres. City of Lodi <br /> Palrlcla E.Vannuccl,Socty, igpi East Has <br /> Avenue,P.O.Box 2009 San Joaquin County <br /> Anlhonatia Van Spronsod City of Eacalon <br /> Earl Plmanldl Stockton,California 95241 city of Manteca <br /> Dania Darn aL.Flouabee 209/486-6781 City of Ripon <br /> I L.Flores City of Stockton <br /> John D. Meat, M.D. City of Tracy <br /> William J.Wada Jog] Khanna, M,D., M.P.H., District Health Officer San Joaquin County <br /> Mary Anne Love SanJoaqulnCounty <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> I, the undersigned owner and/or operator of the property and/or facility <br /> located at 12 0 00 t vii l C�-}_�f. CA . <br /> hereby authorize r <br /> to 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 /> Owner/Operator:A�<- —r' Title: 1-2--,.;-" <br /> Address / �Q�� ?C► Phone: --x/// <br /> ii--x/// <br /> Date: 1i U <br /> FM ------- <br /> --- <br />