Laserfiche WebLink
t ^�, yam . '. � >?� .. '�.. `Tr„tr^�,aF•- 1`.�' `,'• - -- - Y <br /> _ SEPINt1 <br /> City of Lodi <br /> t-wl_TH�1STRICT Joaquin County <br /> $an Joaq Facston <br /> BOARD OF TRUSTEES SAN J0AQUIN LOCAL HEALTH DISTRICT SERVINO <br /> James CulbertaDn, Pres, City Of Lodl <br /> Patricia tt VennSproucci, aeo4y. 1601 East Hazelton Avenue, P.O. Box 2009 San Joaquin County <br /> EarAntl <br /> Van wpronseij City of Eacalon <br /> Earl Su ental Stockton, California 95201 City of Manteca <br /> Fern Bucboe ' <br /> 209/466-6781 City of Rlpon <br /> John D.. Flores City of Stockton <br /> John Mast, M.D. City of Tracy <br /> William J.Wade Jopl Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br /> Mary Anna Love San Joaquin County <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> 1, the undersigned owner and/or operator of the property and/or facility <br /> located at ( o OC2 Wy l a 0 , T-f'- e6_ CA <br /> hereby authorize 1h5=lE <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: ����= �_ - <br /> Title: <br /> Address . Phone: ,S%i-////L <br /> �r <br /> Date: —22 --,�; <br /> r is <br /> 0 <br /> r <br /> t -- - ----- - -- --- -- --- - -- - - - <br />