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• IHVStEES <br /> wt..n.on, r,a,. SAO , OUIN LOCAL HEALTH DIS __ <br /> Pat,ta• E. v.nnuccl. S.c'y <br /> SEH VINO <br /> ^n( p1ma a van Soron,an 1601 East Hazellon Avenue, CITY of Lodi <br /> Earl Plmanlal UB, P, O. BOR 2009 S an JoaQuln County <br /> F.rn e„po.a Stockton, Calllornia 95201 <br /> CIIY of EablOn <br /> Daniel L. Flora 209/466-6781 City of M.nt.c. <br /> John D. Mast, M.O. City of nlpon <br /> William J. Wad• City o(Slocklon <br /> Mary Anna Eor• Jopl Khanna, M,O. M.P.H.. District Hsal(h O((Itr <br /> City of Tracy <br /> San Joaquin County <br /> j' San JoaQuln County <br /> MAY <br /> AUTHORIZATION 10 RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND EWRI). J <br /> SITE ASSESSMENT INFORMATION ME t =TH <br /> P; _ s <br /> I , the undersigned owner and/or operator of the property and/or facility <br /> located at � 13 2 (9 st 'X(✓. <br /> hereby authorize (/ <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 /> Owner/Operator: 1. 11nsa� 0,\rL <br /> iNr Title: o (� <br /> Address c.0 <br /> Phone: <br /> Date: <br />