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0u^AU W 1AUSIEES <br /> J•,n., Culbenaon p,ea SAN J,�.QUIN LOCAL HEALTH DISTRIC-r <br /> ralrlcld E. vannuod, 6K•y SERVINo <br /> .:nlhonalfa Van spronaen 1601 East Hazelton Avenue, P. O. 13ox 2009 San Jo Gtr of Lodi <br /> Earl Fbnentel &qula County <br /> fem aupb« Slockton. California 95201 Gty of E.calon <br /> D&nW L Floc„ 209/466-6781 City of Manteca <br /> Joan 0. Mut. M.O. Gtr of Ripon <br /> W1fMaRt J.Wada Cityof Siodcton <br /> Mary Anna Low J001 Khanna, M.O., M.P.H., 01alf1al Health officer City of Tracy <br /> San Joaquin County <br /> San Joaquin County <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> I, the undersigned saner and/or operator of thero <br /> perty and/or facility <br /> located at P <br /> hereby authorize <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 /> -ewm�/Oper4.tor: /Pc/Jok.� o,yAi� Q Title: <br /> Address 07 7J <br /> req .4.0 Phone: w9- 7 3-80 <br /> Date: <br /> Varner Condmeflma <br /> Jpic. #p-4���44f868 <br /> 7900 When Koaj <br /> 9536Y <br /> EH 08 05 UGT 13 ' <br />