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bOARO Or IRUSI(ES SAN JO,Aj)UIN LOCAL HEALTH DIST RIC SERVING <br /> . <br /> Jamal CultarlfOn, Praf. <br /> Pallid• E. vannuccl. S.c'y. City or Lodi <br /> 1601 East Hazelton Avenue P. O. Box 2009 San Joaquln count <br /> Anlhonall• Van Spronfan , y <br /> Earl PimentelGtYOf Eacalon <br /> Stockton, Calllornia 95201 <br /> Farn BupOee City Of Manteca <br /> Oanlel L. Florej 209/466-6781 City of Ripon <br /> John D. Me$t. M.O. CRY Of Stockton <br /> William J. Wade Jopl Khanna. M.O., M.P.N., Weldcl Health Office( City of Tracy <br /> San Joaquin County <br /> Mary Anna LoveSan <br /> Joaquin County <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS. GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> I . the undersignedown rand/or operator of the property and/or facility <br /> located at � k 6marrK t <br /> hereby authorize11114G'" kJ <br /> '�� IY , L <br /> to release any and all analytical resul s. 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 /> Owner/Operator: Title: ��,�_ —� <br /> Addresss �." Phone: <br /> Oatc: <br /> r <br /> Cil 08 05 UGT 13 <br /> a <br />