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eoAao or IRUSIEE5 SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> Jsmer Cu1Le,13on, P,es. SERVINO <br /> P•I,KIa E. Vannvcci, Secy. City 01 Lod] <br /> San Joa <br /> Anthonatta van Spfonsen 1601 East Hazelton Avenue, P. O. Box 2009 qutn County <br /> Es,l Plmentel Stockton, California 95201 City of Escalon <br /> Fern Bupoee City of Manteca <br /> Daniel L. Flofea 209/466-6781 City of Ripon <br /> John 0, Maal, M.O. City of Stockton <br /> William J. Wade Jopl Khanna, M.D., M.P.N., District Health Officer City of Tracy <br /> San Joaquin County <br /> Mary Anna Low San Joaquin County <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> I , the undersigned owner and/or operator of the property and/or facility <br /> located at p S <br /> hereby authorize f <br /> to release any an all analyt cal results, geotechnical data and site <br /> dssessment 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 /> Address AA <br /> Phone: <br /> a. <br /> Date: — <br /> EH nA n5 i1GT 13 <br />