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a <br /> James CQu4f6anson.'Nos. S OAOUIN LOCAL HEALTH DIS IM& <br /> _ <br /> FIGItAI 4. Vannucd, Sac*r•. SERVING ... <br /> A�nflioaejje Van Speonsan- 1601 EasuHatohon Avenues P: ®. ®ox'20Q9 San Joaquin <br /> tato Ptmantal cit r <br /> of Lodi <br /> county <br /> Fs4n Ougboo Stockton.. Calflomia95201 city ofEscaton <br /> 0an1®f L. floras 209/4Gfi-6781 tatty of Manteca <br /> John O. Mast. M.0. _ city of Ripon <br /> William J. Wad® Joel Khanna. . MPcity of Stockton <br /> Mary Anna Love M.O.. . .H.a District Health Otficw Clty of Tracy <br /> San Joaquin County <br /> San Joaquin County <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS. GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> t <br /> I. the undersigned owner and/or operator of the property and/or *facility <br /> located at <br /> cif <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 /> Owned/Operator7 ` � Title: <br /> Address ' _ <br /> Phone: Z <br /> Oaee: <br /> e <br /> H 08 OS UGT 13 <br />