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Eart Firnernel <br />Fpm 8 2()9/466-6781 y City of Stockton <br />Daniel L. Flores City of Tracy <br />Jahn D. Mast, M.D. Joaquin County <br />WNfi J. Wade Jogi Khanna, M.D., M.P.H., District H f'J ficer San Joaquin County <br />Mary Anna Love <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 />� 5 <br />located at <br />hereby authorize <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: <br />? Title: <br />Address <br />711:, <br />�-_ Phone: <br />Date:` <br />JOAQUIN* DISTRICT <br />SERVING <br />SAN <br />City of ., <br />Joaquin <br />1601 East Hazelton Avenue, P. 0. Box 2009 <br />City of Escalon <br />952D952DI <br />city. w'. <br />Eart Firnernel <br />Fpm 8 2()9/466-6781 y City of Stockton <br />Daniel L. Flores City of Tracy <br />Jahn D. Mast, M.D. Joaquin County <br />WNfi J. Wade Jogi Khanna, M.D., M.P.H., District H f'J ficer San Joaquin County <br />Mary Anna Love <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 />� 5 <br />located at <br />hereby authorize <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: <br />? Title: <br />Address <br />711:, <br />�-_ Phone: <br />Date:` <br />