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•q^Ao am 1AUS1EEs. S*40UIN LOCA <br /> J•m..'t„Il,.n,on P,., L HEALTH DII• <br /> ' <br /> P.1.I(la E. VannuCCI. $ac't SEAVINo <br /> Anthonalta van Sp...... 1601 East Hazelton Avenue, P. O. Boit 2009 911'of Lodi <br /> E.,I Plmanl.l S.n Joe County <br /> Fa,n BupO.. Stockton. Callfornia 95201 City of Eacalon <br /> Daniel L. Flora 209/466-6781 City of Maniacs <br /> John 0. Mast, M.D. city of nlpon <br /> William J. Wad. City of Slocklon <br /> Jopl Khanna, M.O., M.P.M„ District Health O(flcw City of Tracy <br /> Mary Anna lov San JoaQuln County <br /> San JoaQuln 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 <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 salve time it is provided to me or my <br /> representative. n <br /> Ownef/Operator: a,mel Ot 29" �� <br /> � 'a _Tit1e: I1/tQJ� <br /> Address j S 2� �U%r :�T r Phone: <br /> I '- <br /> r. r) <br /> ENV'IRO..MENTAL HEALTH <br /> FERDAIT/SERVICES <br />