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, ,. • . . ,. i Il /1t 111 1/i.ii 111\. 1 1 <br /> 1' I.ic F. <br /> if. %' [' Citi Of t udI <br /> Anlhonella Von Splonlan 1601 1-AS1 Hazellon Avefluo, N. O. I1Ua AX-0 AjoaQQ1nCoun1y <br /> Earl Plmanlei Stockton, California 95201 City of EacSion <br /> F*in BuoQee City of Manteca <br /> 0anle7 C. Flores209/466-6781City of fiipon <br /> John Cl. M„t, M.Q. City of Stockton <br /> City of Tracy <br /> William J. Wade Jopl Khanna, M.D.• M.P.N., Dlatricl Ffeatlh Officer San Joaquin County <br /> l.Rary Anna l.oye San Joaquin County <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> t <br /> i <br /> I . the undersigned owner and/or operator of the property and/or facility <br /> located at .� <br /> hereby authorize <br /> to release any and alf analytics 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 /> Owned'/Operator Title: <br /> Address ( Phone: <33�- �tBS� <br /> Hate: t� S <br /> I . <br /> I <br /> EH 08 05 UGT 13 <br />