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Gll�pli u�l <br /> r II,U. ..ASI ll-Vi iwl Aven1/o,i', <br /> If• V.11 ry1Pn �R Q Ili), 1I1t1`J .a Jot iAc(i <br /> Im.n1.1 Stockton, Cdlllofnli 95701 clly W 1,c.lcn <br /> ern r►M80�. clf V of MOnjoce <br /> 3: Jet L. F1.11200/46G-6181 64r of nlPon <br /> Jr *'�, Blast, M 0 1 o Slocalon <br /> 4111 J. Woof Jugl Khanna. M.o., m.P.H.. oialtI.,lIuUR 0i(icsr Clip of 11611 <br /> 4--1 Anne Love Safi JoaquIn County <br /> San.10641 C*unl8 <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> JITE ASSESSMENT iNFOPMATiON <br /> the undersigned owner and/or operator of the property and/or facility <br /> located a: _ �_( _ , �, i� •� <br /> "hereby authorize <br /> _ .o release any and all analytical results, geotechnical, data and site <br /> 4sse$SMent information to the San Joaquin Local Health District as soon- <br /> . <br /> oon- <br /> �t is available and at the sante time it is provided to me or my <br /> representative. <br /> Title: <br /> { dregs 00 . ), -1, n Phone: <br /> 95-31-' ,l•�� <br /> Ste: <br /> a <br /> iroe as UGT 13 <br />