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UGARUDyIRUSttls SAN JOAOLIIN LOCAL. HEALT H UISTHICT <br /> !art-ea Cur(ronaun, Pray SERVING <br /> Paurcla F. vhnhuccl. Sac'y CltyofLod, <br /> Ann,Uhalle van $p,ninon 1601 Fast hia)elton AYenue. P O Box 2(x19 San JnaQulncounly <br /> rail n,n,onlal Slocklon. California t4`1201 City of ESC a len <br /> fern Dupoaa City of Manteca <br /> Daniel L. Florey 209/466-6781 City of Rlpon <br /> John D. Mast, M.0 City of stockton <br /> William J. Wads Jopl Khanna, M-D , M.P.H., District Health OfficerCity of Tracy <br /> Mary Anna Lo.e an Joaquin County <br /> `•ar•Joaquln County <br /> f' <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS , GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> nr <br /> 1 , the undersigned owner and/or operator of the property and/or facility <br /> located at <br /> -- —y— <br /> hereby authorize / 4 <br /> to release any and 1 analytical results , gear hnical 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 /> - <br /> OwnJ/Operator: Title: --U, <br /> Address n �� 1! a � _`- -- --- -- - �� - <br /> � �—�_j ��_ _Phone: <br /> Date: <br /> I-. <br /> �i <br /> rf <br /> 1 f <br /> Wi <br /> i��'�10 <br /> 1. � <br /> 3•: <br /> i a <br /> 3; <br /> a <br /> aK- a EV P•4.P <br />