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aoano or t=austEEi SAN JC+.OUIN LOCAL HEALTH DISTRICT' <br /> J.ma• Cuio.n,.fn, P..,. <br /> rat.tct• °. v.n�,.ct:f. S•c.y _ SEavrHO . . <br /> Anlhon•lf• vnSptoh,an 1601 East Hazcllon Avenue, P. O. Boa 2009- San Joe IIT of Lodt <br /> E•,I Plmoniaf - - - - Quin County <br /> F•ro BupD•• _ <br /> Stockton, Callfornia 95201 cllyol E,caton <br /> Daniel L. Flot•a 209/466-6781 - - City ofMant.ca <br /> John D. Mast. M.D. - City of Ripon <br /> City of Stockton <br /> William J. Wad* Jopl KAanna, M.D.. M.P.N„ 018010 Health Offkar City 01 Tracy <br /> Mary Anna Lova San Joaquin County <br /> San Joaquin County <br /> AUG^ 28 M7 <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND ENVIROMENTAL HEALTH <br /> SITE ASSESSMENT INFORMATION VERM1T/SERVIOES <br /> 1 , the undersigned owner and/or operator of the property and/or facility <br /> located at ` <br /> hereby authorize Q <br /> to release any and all analytical res its, geot chnical data and site <br /> dssessment 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 /> OwneWperator: <br /> / -1-3todaYvQ Cunt <br /> AddressTitle: <br /> Phone: <br /> Date: 87--Z-4--F7- - - - <br /> 6 7 <br /> 711 08 05 UGl 13 , <br />