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0UAMtj Ur IAU.NIt t ' SAN ,WOUIN LOCAL 11EALTII DIST R* SLRVINQ <br /> James Culbertson, Pies. <br /> Oatricta E. Vannucct, SecCity of LOCIy. <br /> AnlDonette Ilan Spronsen 1661 East Hazelton Avenue, P. San Joauin Count 0. Box 2009 G y <br /> Earl Pimentel Stockton, California 95201 City of Escalon <br /> Fern Bu®bee City of Manteca <br /> Daniel L. Flora' 209/466-6781 City of Ripon <br /> John 0. Mast, M.O. City of StocktonCity of Tracy <br /> William J. Wade Jo®I Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br /> Mary Anna Love San Joaquin County <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> I, the undersigned owner and/or operator of the property and/or •facility <br /> located at �, A-, L � �cQ ,,, �v� v �AA <br /> hereby authorize �.MCc,U AS ' <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 /> er/Operator Title: <br /> Own <br /> Address /`�D o fj'/� Phone: o?ol- -22 7S <br /> �x 7To AJ, Cid Sa® <br /> Date: <br /> EH 08 05 UGT 13 <br />