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FROM - <br /> �... 06/0'9i96 ..I 2 r st;`4 . P. 7 <br /> OOARD OF j TfltleTEis 'SAN JOAQUiN LC7CAL HEALTH DISTRICT <br /> Jamas dulbrrtson, Pra&, 91sIEVINQ <br /> Patriall E. vannucol, Sealy, '4 Clty of Lodi <br /> Anthonstto van BpronMn 1601 EASt Hazelton Ayt�nuc P gts <br /> Bu0. Box 2000 Sara JQPQUIn Oounty <br /> POrn 8u1gb 8t <br /> oo <br /> eat kton, oslifoCnl�;= 8201 Olty al-Eecalon <br /> ee oil y of Manteca <br /> Dental L. Flofis 20A14I �7 1 Olty of-Rlpon <br /> John 0. Most, M.D. - oky of stooktan <br /> Wllillm J. wady <br /> Mtsey Ann*Lour Joel Khanna, M,D„ M.P.H.,.Dlstrlct mealth offtov. 01ty 61 V64y <br /> son Jvsquln 00unty <br /> Bin Joaquin County <br /> AUTHORIZATION TO AELEASE ANALYTICAL RESULTS# GEOTECHNICAL DATA AND <br />;= -$ITE ASSESSMENT INFORMATION <br /> 1, the undersigned owner and/or operator of theproperty and/or 'facility <br /> located At s"iS A.14VP IV .�Fw. <br /> hereby authorize <br /> - � � IAC. L,Ar'✓ IN�.�iNG to release any and, 8.11 analytical resultils geotechnical data and site <br /> assessment information to the San Joaquin Local Health District as soon <br /> a-s it is available and at the same time it is <br /> provided to me or, my <br /> representative. <br /> Owner/Operator: <br /> . <br /> Title: ffana er, Health Safety A <br /> Address 511 Hort Broo r nvironn-ental Pro ' s <br /> Phone: act , <br /> Ar�dh I m CA 9280 714-520-3586 <br /> Rate: <br /> ur:e <br /> _ y.{ C(DPY i <br /> z <br /> i <br />