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-- -- -- *lai San Joaquin County <br /> PatriciayE: vannuccl. Secy. 1601 East Hazelton Avenue. P. O. Box 2009 City o1 Escalon <br /> Anlhonelle Van Spronsan City of Manteca <br /> Earl Pimenlel Stockton. California 95201 <br /> City of Ripon <br /> Fern Bupoea 209/466-6781 City of Stockton <br /> Daniel L. Flores City of Tracy <br /> John D. Mast. M.D. <br /> ,Vllllam J. Wade Jopl Khanna, M.D., M.P.H., District Hoallh officer San Joaquin County <br /> San Joaquin County <br /> Mary Anna Lore <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION - <br /> Cc <br /> �J <br /> I , the undersigned owner and/or operator of the property <br /> and/or facility <br /> located at <br /> hereby authorize <br /> to release any and all ana ytical 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 /> d <br /> Owned/Operator'� <br /> Address Phone` q[aln— 31 � <br /> ti <br /> Date � �<:S- <br /> ORIGINAL <br /> EH OB 05 UGT 13 <br />