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•CMaMMan,has. �""" ••••••••••••• wvn` nGNllfl Ir+.l1 f11VI <br /> 41 Ana&Lam,Vim SERVI <br /> / 1601 East MatNbn Avom% P.O.Box 2009 Ckr of L <br /> t fan Joaquin cou <br /> F�n PMWW" S10CIdOn, C4111110tNa 95201 aan Joaquin cou <br /> Wgink meow" City of Eau <br /> DuWI L,florae (209) 166-6761 ci%of Mani. <br /> Jam o.Mae%M.D. Cky a ail <br /> Unna a.Krohrn Baal Khaaaa,MA,M.t•.R,OlaYld M..nn oft. city of Sock. <br /> CRY al Tre <br /> San Joaquin cou. <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> I , the undersigned owner and/ot- operator of the <br /> located at 'SProperty and/or facility <br /> �rn c v 1 C Clip( <br /> hereby authorize —f L <br /> to relellse any and all analytical results <br /> ata <br /> assessment information to the San Joaquin Locale Health lDistrictdasite soon <br /> as it is available and at the same time it is provided to me or my <br /> representative. <br /> p 4^I 3 <br /> Owner <br /> fU erator: <br /> Address t� F— Title: <br /> CO. Phone: <br /> i <br /> Date : <br /> r <br /> FII 08 05 UGT 13 <br />