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�jj III0=1111 11 0,11 1 11 11 <br /> I <br /> WARD of tnustEEs SAN JOAQUIN LOCAL HEALTH DISTRICT SEAVINa <br /> ,ames Culbertson, Pres Clly of Lodi <br /> '&I-Ocie E, Vannueci. SaC'y San JoaqutnCounty <br /> ibOt East Hazelton Avenue, P. 0. box 7'J09 <br /> +�!" fe Von Sarnnsa++ Clty of Estalon <br /> ar .� ;nisl Stockton, Callfornia 95201 Cllyof maniacs <br /> i9' u9oe° <br /> Guy of on <br /> 209/466-6781 <br /> )anlel L. Flores City of Stoccktkton <br /> ohm D. Mast, M.D. CuC-hy of y <br /> Jlfflun J.Wede Jogl %henna, M.D., M.P.H.. Dleirtet Health OfliGer SanJoaqInlnCoumnty <br /> 4ary Anna Lara San JoaquinGouniy <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> '41 TE ASSESSMENT INFORMATION <br /> I, the undersigned owner and/or operator of the property and/or facility <br /> located at Port of Stockton, 2201 W. Washington, Stockton, CA <br /> hereby authorize _ Canonie Environmental , Stockton, CA <br /> MR tn.release any and all analytical results, geotechnical data and site <br /> .ssment information to the San +}oaquin Local Health District as soon <br /> as it is available and at the same Lime it is provided to me or my <br /> representative. . <br /> PORT OF STOCKTON f7 <br /> Owner/Operator: J.—�_cec. Y� Title: <br /> Address <br /> P. 0. Box 2089 Phone: <br /> 946-0246 <br /> Stockton, CA <br /> Date: /"X <br /> i <br /> I <br /> Est 08 05 UGT 13 <br />