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MOwhO OF IRUSI EES <br /> Jamar CulWnron, Pier. SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> Palficia E. Vannuccl, SaC,y. SERVINO <br /> Anlhonalle Van Sp,on,an 1601 East Hazelton Avenue, P. O. Bou 2009 San JO. Clly of Lodi <br /> Earl Plmenlal quln County <br /> Fun Bupoaa Stockton, Calllornia 95201 City of E,caton <br /> Oanlel L. Flora, 209/466-6781 City of Mantaca <br /> John 0, Masi. M.O. City of Ripon <br /> William J. Wade City of Stockton <br /> Jopl Khanna, M.O., M.P.H„ Olalrlcl Heallh 01ficw City of Tracy <br /> Mary Anna Low San Joaquin County <br /> San Joaquin County <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> 1, the undersigned owner and/or operator of the property and/or facility <br /> located at / <br /> hereby authorize vA/T�L, ,2 <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 /> A-LZ2�=-, <br /> Owner/Operator: Title: <br /> Address Lf / <br /> Phone: <br /> Date: /j—I 44 <br /> aw <br /> NOV 1 r.' 1986 <br /> ENVIRUMENTAL HEALTH <br /> FERMIT/SERVICES <br /> r <br /> Eli 08 05 UGT 13 <br />