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� •r <br /> FROM 21.3 267 5089 Y 7 VS P. 1 <br /> •rnsi(,'y�Lwtlaan, P�oz, C€ty at tod+ <br /> titter�a <br /> C. VannuW, OC'Y. 1 +01 East i-itzeltan Akvanue, P. 0. BOA wh Joa&gostn Cown4y <br /> knthonstte V&F' SP410"60R city Flews h <br /> ;aft Ptnaantat Stochi on, Callicoenlis City at mditn ibt_ <br /> emyirerftnte!A1Fvn <br /> aevgtm Cityof 61004900 <br /> !R. "6f . <br /> �1xn b, trErrsl, M.D. city G(rricayr <br /> f!!tl�At J. VYadd Jogs Khanhfi, M.D.. FA.P.W. WARM HGAIttt 0"I"f San 464gw1ft COUMY <br /> my Ansa Love San ja&gwlo Caunty <br /> r <br /> AUMORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFOWTIOH <br /> ;, the undersigned yawner andtor operator of the prop+erV and/or 'facility <br /> located at <br /> ' .. r....,.. , <br /> hereby authorize <br /> to release any and all analytical rasults, +geotachnical data and site <br /> dssessmant %formation to the San Joaquin Local Health District as coon• <br /> available and at the same time. it is rovidbd to me or OW <br /> as itisa r p , <br /> representative, <br /> O mADperatom Title: <br /> d <br /> Phones <br /> ,Ad rays ��;�'��� •.�-���t. - , <br /> f <br /> � ff <br /> t <br /> } , i <br /> f <br /> t <br /> f <br />