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U�1n1�.1 SERVING <br /> Jamw CWpMhun,Pna City d Lodi <br /> * PAWS E aMary'Anna .ovq Vloa Pm. 1601 Ead Hazelton Avenue, P.O. Box 2009 San Joaquin county <br /> Mnuxt,8at.y. San Joaquin County <br /> TOM"Joyce Stockton,Calltomla 95201 q <br /> Earl Pini"401 City of Escalon <br /> VtrQlda mow" (209) 466-6781 City of Maniacs <br /> Da„ial L Bot" city of Ripon <br /> John 0.M"%M.D. JOO Khuw,M.O.M. H.DWMd H..nh Dtacor citY d Sloeklon <br /> ,r Gana 8."WW" <br /> City of Tracy <br /> San Joaquin County <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> I , the undersigned owner <br /> and/of- operator of the property and/or facility <br /> located at I�ol1 �l�R•-� CK— <br /> hereby authorizer <br /> to relehse 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 /> S Tt-'°.'.'� l7 X13 vl��+•.� <br /> Owner/Operator: a _� <br /> I � Title �� <br /> : , C, <br /> Address 1 �.� �D�gl J Phone: <br /> Date : ) (� • f <br /> EH 08 05 UGT 13 <br />