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1t)01 i_ast Haielion hvenua, Y. O. (10% AXfJ '•^�oaaulnCo., <br /> ,J+unelte Von raV+Posen - - +y CISy'GOEIC.10 <br /> all Pimento, Slockton• Cafflornia 95201 <br /> Clir o1 ManteC► <br /> F.in Bugc:e 209/466-6781 City of Ripon <br /> Daniel L. Fiotef City of siockion <br /> John 0. Ma3t, M.D. Cltyof Tracy <br /> Nlliiam J. Wade Jog! Khanna, M.D„ M.P.H., Dfahicl Health 0111cef San Joaquin County <br />"ary Anna Lore — San Joaquin County <br /> I <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> I <br /> I , the undersigned owner and/or operator of the property and/or *facility <br /> located at ��S �,r��//f,,rJ,s �lPc. �,� <br /> hereby authorize _ llce�.rrd�A �- T'`��'� / 7-v� _ '7 <br /> to release any and all analytical results. geotechnical data and site <br /> -issessment information to the San Joaquin Local Health District as soon- <br /> as <br /> oonas it is available and at the same time it is provided to me or my <br /> representative. = _ <br /> Owner Operator: Lvz Ca t bCcirnosTv�4kI.= --17cac Title: <br /> Address -JDl `�"�' �S Phone: <br /> - I <br /> C <br /> Date: <br /> EH 08 05 UGT I3 � .G. <br />