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�-•��' SAN JOAQUIN LOCAL HEALTH DiSTNtCT � <br /> iIEAyING <br /> I.w... C�a.nw., ► .. CAT d 4.*41 <br /> "-V VIC.r100 1601 East Hesellon Avenue, P.O. Boli 2019 466qw"co,"IT <br /> Lew s0+4 Gw01y <br /> rammr J&rca Stockton, Cal lomis 93201 qKY w Eac.asa <br /> ted I11ftewtd <br /> GIT Of 14WA.ca <br /> vrrw.t►es+.... (2091466-6741 <br /> c+`r r a4bon <br /> C"M ibdclw. <br /> l64 KArwwti M 0. WPM.Dwbw"*am O"CM `-'7 ad 1'"I <br /> MM IL 1 afte w 1M 4"qw"C~41 <br /> UE - 1 32 <br /> AUTHOR I ZAT I OMR <br /> T4 PLEASE ANALYTICAL RESULTS. GEgTECI1NICAL ❑A'L'A AND <br /> SITE ASSESSMENT INFORMATION <br /> I , the undersigned owner and/or operator oft the property and/or facility <br /> 3 ocatcd at stt�groc TO" c, S e <br /> hereby authorize �_�_ �''1 C-0a p <br /> to release any aad all analytical results, geotechnical data and sit4 <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 aye or my <br /> representative . <br /> Owner o fG- <br /> f ncrxtor Gf/a Ti t Ie, . Q <br /> Ad I i Phone. <br /> C/.% spa <br /> Eft 08 05 UGT 13 <br />