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aftUAlic iwf 1:tLS1Cf$ , A <br /> SAN JOAQUIN LOCAL_ HEALTH DISTRICT a SERVING } <br /> James Cultion3on, Pros. <br /> '0alr4cla E. Vannuccl. See•y. City of Lodt <br /> Anlhonette Van Spronsen 1601 East Hazelton Avenue, P. 0. Box 2009 San Joaquln county <br /> Earl Plmentel City of Escalon <br /> Stockton. California 95201 <br /> Fern Rupee y City of Manteca <br /> Daniel L. Flores I 209/466-6781 City of Ripon <br /> John D. Mast, M-D. City Of Stockton <br /> Wlfllam J. Wade Jogi Khanna, M.D., M.P.H., District Health Officer City of Tracy <br /> Mary Anna Love San Joaquin County <br /> San Joaquin co"U' tty <br /> e <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 rkj <br /> hereby authorize ;5LMCQ <br /> to release any and all analytical results, geotechnical data and site r <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 /> r - <br /> Owne /OperatorTitle: may' <br /> Address Phone: v��--4`41 - z;7.S- <br /> Date: <br /> - I <br /> I. <br /> I' <br /> EH 08 05 UGT 13 <br /> t <br />