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-eAN JOAQUIN LOCAL HEALTH DISTRICT <br />SERVING <br />1601 East Hazotlon Avenue, P.O. Boz 2009 Cey of Codi <br />San JoWuln County <br />Stockton, Calffomla 95201 Son Jowfukt County <br />Cay of Escabn <br />(209) 166-6761 CRY of Manteca <br />CRY of Rfpm, <br />Joel Kkwma- KD4 "Ji, w.Ma ""M 00co, -Ity of Stockton <br />City of Tory <br />Son JUQufn County <br />AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br />SITE ASSESSMENT INFORMATION <br />I, the undersigned owner and/of- operator of the property and/or <br />located at facility <br />_ <br />hereby authorize n, f A (I <br />to release any and all C r <br />analyticutl results, <br />te <br />assessment information to the San Joaquin Local eHealth lDistrictdatadaslsoon <br />as it is available and at the same time it is provided to me or my <br />representative. <br />Owner/Operator: <br />Address Title` <br />41 <br />Phone: <br />Date: r S f <br />EH 08 05 UGT 13 <br />2/PS <br />iOARO OF TRUSTEES <br />Cwbwbw% Fns. <br />Mary Anne 1,*M V100 prc <br />+r <br />To,"My Joyce <br />r <br />EM ►knonld <br />Vkpk,y Movwo <br />Dwdd L FIe fto <br />I,. <br />i� <br />Gone L Wdtwn <br />-eAN JOAQUIN LOCAL HEALTH DISTRICT <br />SERVING <br />1601 East Hazotlon Avenue, P.O. Boz 2009 Cey of Codi <br />San JoWuln County <br />Stockton, Calffomla 95201 Son Jowfukt County <br />Cay of Escabn <br />(209) 166-6761 CRY of Manteca <br />CRY of Rfpm, <br />Joel Kkwma- KD4 "Ji, w.Ma ""M 00co, -Ity of Stockton <br />City of Tory <br />Son JUQufn County <br />AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br />SITE ASSESSMENT INFORMATION <br />I, the undersigned owner and/of- operator of the property and/or <br />located at facility <br />_ <br />hereby authorize n, f A (I <br />to release any and all C r <br />analyticutl results, <br />te <br />assessment information to the San Joaquin Local eHealth lDistrictdatadaslsoon <br />as it is available and at the same time it is provided to me or my <br />representative. <br />Owner/Operator: <br />Address Title` <br />41 <br />Phone: <br />Date: r S f <br />EH 08 05 UGT 13 <br />2/PS <br />