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of 114USIECS SAN JOAQUIN LOCAL HEALTH DISTRICI SERVING <br /> CuiGen.on. Pre,. City of Lodi <br /> j, E. V.nn.ccl. Secy. 1601 East Hazetlon Avenue, P. O. Box 2079 San Joaquln County <br /> .roneit• Ven SPronren City of Eacalon <br /> a vi,nentei Stockton. California 95201 city of Manteca <br /> 'n BuOD" 209/466-6781 of kion <br /> City <br /> oof 5l ockl <br /> nlel L. Floret f on <br /> in O. Maul. M.D. City of Tracy <br /> Alam J. Wade Jopl Khanna, M.D., M.P.H.. District Health officer San Joaquin County <br /> ry Anna Luve 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 /t ff_ %./Ayy I yJC F57cc,�ioN CA . <br /> -- r. <br /> hereby authorize J tI KLC1n1FCc-0EQ <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 /> Ownef/Oper4jtor: Title: iroAls'T Nle <br /> Addressy yV G/— +A kVA,Y Phone: ¢G,6-5,n81a <br /> S i oc l�7aN C A. ey 5 Ze D <br /> Date: <br /> ( if 08 Or; 11GT 13 s e <br />