Laserfiche WebLink
sees SAN JC IUIN LOCAL HEALTH OISTRIC. <br /> V. <br /> P.... SLRVING <br /> v.""uccl. S.c,r City of Lodi <br /> n.,l. V.n So,on..n 1601 East Hazelton Avenue, P. O. BOK 2009 $.n Jo.Quln County <br /> P1m•"'•' Slocklon, Callfornia 95201 Cltyof E.c.lon <br /> .m nip Ue. City of Maniac• <br /> .niel L. Flo(a, 209/166-6781 <br /> City of Ripon <br /> )hn 0. Mu(, M.O. City of Stockton <br /> Illlam J. Wada Jopl Khanna. M,O.• M.P.H.• Olatytd Health offlcu City of Tracy <br /> ary Anne lova San Joaquin County <br /> San JoaQuln 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 1Lobl ( <br /> AAAA rf. l C< ✓] � ' 0 �& <br /> Y I wi <br /> hereby authorize _fF-p u(f4 (fes �YF�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: � cQ ` 6,� Q cE -Vji tie: Cba . >� <br /> Address %1c) (3¢0, 6( 0,4-K �—Phone: 2�/c 1_3g7p <br /> -Mo>�d1D C A <br /> Datc: 32"7 /S-7 <br /> •f 0A nC IIGT 11 <br />