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bUkk" Of IHUS itlS SAN )AOUIN LOCAL HLALI li UISI ' ;T <br /> SL RVIND <br /> Jemea Cullen son, Pea. �'� �� <br /> f Lodi <br /> PaIr ICIa E Vannuccl, Secy. <br /> City oounty <br /> Anlhonane Van Spronaan 1601 East Hazelton Avenue, P. 0. Box 2(X19 San Joty of County <br /> City of Eacalon <br /> Earl Pimeniel Stockton, California 95201 City of Manteca <br /> Fern Buphee 209/466781 City of Ripon <br /> Daniel L. Flores City of Stockton <br /> John D. Mast, M.D. City of Tracy <br /> William J. Wade Jog[ Khanna, M.O., M.P.H., District Health Officer San Joaquin County <br /> Mary Anna Love San Joaquin County <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> I, the undersigned owner and/or operator of the property and/or facility <br /> located at ;, <br /> hereby authorize 7 , r e, % z5' <br /> to release 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 /> Owned/Operator. . Title: <br /> Address 12 / N Phone: <br /> ,f>of�/lc✓ jqr/�� <br /> Date: /i �6+� <br /> a <br /> EH 08 05 UGT 13 <br />