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EOA;100E 1RUSIEES <br />,. James C^srlson, Pref. <br />Padlcln E. Vannuccl, Secy <br />AntKonelle Van Spronsen <br />Earl Pbnentel <br />Fern Bugoes <br />Daniel L. Flores <br />John D. Most, M.D. <br />✓ illiam J. Wade <br />Ochry Anna Love <br />SAN JADUIN LOCAL HEALTH DISTRIC0 <br />1601 East Hazellon Avenue, P. O. Box 2009 <br />Stockton, Callfornia 95201 <br />209/46"781 <br />Jog[ Khanna, M.D., M.P.H., District Health Officer <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 130 \ `_ c c CoFl(1 �g <br />T, -0,11 I C10", . <br />hereby authorize r�vtc�_S'!= /�Jku�. CJA-Te <br />to release any and all analytical results, geotechnical data and site <br />dssessment 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 />SERVING <br />City of Lodi <br />San Joarluln Counly <br />City of Escelon <br />City of Manteca <br />City of Ripon <br />City of Stockton <br />City of Tracy <br />Sen Joaquin County <br />San Joaquin County <br />0 <br />Owned/Operator: Title: V/a <br />AddressQ L Phone: 3 U_U.70 <br />Date: <br />EH 08 05 UGT 13 <br />