Laserfiche WebLink
1 ,na. CulWnaon.e0 007 IftY <br /> unPSAN JOAOUIN LOCAL HEALTH DIST RIG 1 <br /> P.0.aa. SERVIHO <br /> aulaa E. Vannuccl, Sac'y. Cay of Lodi <br /> nthon.aa van Splonaan 1601 East Harellon Avenue, P. O. Box 2009 San Jo.gLfn County <br /> 411 Plmanlal Stockton, California 95201 Gtyof Escaton <br /> am aup0aa Cay Of Maniacs <br /> anhsf L. Floras 209/466-6781 <br /> Gly of Ripon <br />�hn 0. Mast, M.O. Gty of Stockton <br /> 1111am J. Wada Joel Khanna, M,0„ M,P.N., Oldrbt Health Officer Gtr of Tfacy <br /> ary Anna Lova San Joaquin County <br /> San Joaquin County <br /> Ire ? I <br /> +tY <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND ENVIRO--VENTAL HLALTH <br /> PERMIT/SEnVECES <br /> SITE ASSESSMENT INFORMATION <br /> 1 , the undersigned owner and/or operator of he property and/or facility <br /> located at <br /> hereby authoriz <br /> to release any and all analytical resu geotechnical data and site <br /> assessment informtion to the San Joaa in 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: z Title: <br /> Address QIP phone: <br /> oacc: ��i <br /> I <br /> r <br /> nR nc 1107.1' 11 I <br />