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3• <br /> o0A�_ 1iC1EES SAN J QUIN LOCAL HEALTH DISTHICFJ SLRVlod <br /> J.., Cufbertaon. Pies. Ct1y of Lodi <br /> palr1cle E. vannuml. Secy, 1601 East Hazelton Avenue. P. O. Box '009 San Joaquin to('sceloy <br /> Anthonelle Ven Spronaen City at E�telon <br /> Earl Pimanfel Stockton. California 95201 City of Maniacs <br /> Fain Rug6ae 209/466 6781 city of Ripon <br /> Daniel L. Floret City of Stockton <br /> John 0. Most. M.D. city of Tracy <br /> William J. Wade Jogl Khanna. M.D.. M.p.H.. Dletrfcl He911h Officer San Joaquin County <br /> Mary Anne 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 r�6 <br /> hereby authorize S <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: T e Qy C Title: t_ 'FC re rt MJ,E' <br /> Address _ 1 y 61� S. G : roc,j 54 Phone: <br /> Date: <br /> [H 00 05 UGT 13 <br /> .i <br />