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ao.ao or Inusitts SAN JOAOUIN LOCAL HEALTH DISTRICT <br /> l.ma Cufb.n.on, P,.., SCRVIHO <br /> Psiolc I. C, Vannuccl, S.c,y City of Lodi <br /> Anihonall• Van SMonf.n 1601 East Ha[ellon Avenue, P. O. Doc 2009 San JoaQuln County <br /> (..t Plmam.i Stockton, Callfofnia 95201 City of Escalon <br /> 0.0t)..n Oop .a city of Maniac. <br /> Daniel L. Flo.ea 209/466-6781 City of Ripon <br /> John 0. Mast, M.D. City of Slockton <br /> William J. Wade Jopf Khanna. M.o.. M.P-H., District Health CHIC r City of Tracy <br /> Mary Anna Love San Joaquin County <br /> San Joaquin County <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS. GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> 1 . the undersigned owner and/or operator of the property and/or facility <br /> located at /-/ — ���/� Go /. <br /> hereby authorize <br /> Lo 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 salve time it is provided to me or my <br /> representative. <br /> Owned /Operator: � <br /> Title: <br /> Address �� � 9� 7 Phone: o?pyr_ �S�cJ <br /> Da <br /> f 11 no nc nl:i 17 a <br />