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v .. <br /> euANO or tRut s <br /> Cul;,nrleUn. SAN JOAQUIN LOCAL HEALTH I)ISTHICT <br /> .4 rte] Pie] SERVING <br /> Pabic la E :'annvccl Secy City ofIodi <br /> Aollq+nalte Van S;,,;,n,,,. 1601 Fast iialclton Avenuo, P O Hoz 7(k)g <br /> San Joa Quln Co unly <br /> Fern fJ vgl)eFee <br /> Fail Pi el Stockton, California 95201 City of F]calon <br /> City of Manteca <br /> Daniel Flores 209/466-6781 city of Ripon <br /> John D.. Mast, M.D. City of Stockton <br /> William J. Wade Jogl Khanna, M.D., M.P.H., District Health Officer City of Tracy <br /> Mary Anne Love San Joaquin County <br /> 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 Stbucrar,..t xj,,, (63z 00VAD0 Si <br /> hereby authorize Cuf gw1.. Lib % WAGUAte.ar �zNY1Rc7fdMF. ��AL <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 /> Owned/Operator: lw� 6c" , m <br /> Title: <br /> Address A2 bo (b1 0 Phone: 4W-ltD1 <br /> Date: N Abtc, ti. <br /> EH 08 05 UGT 13 <br />