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00^AO of 1AUSTEEs SAN AMN LOCAL HEALTH OISTRICt SERVING <br /> J.me. Cul"nson, Pte.. <br /> P.ulcle E. Vannuccl, Secy. City of Lod( <br /> Anfnoneue Van Spiomen 1601 East Halelion Avenue, P. O. Box 2009 San Joaquln County <br /> E•'I Pimentef Stockton, Callfornia 95201 Gly of E&colon <br /> F•in 9upDe• <br /> City Of Manteca <br /> Oanlef L. floret 209/466-6781 City of Ripon <br /> John 0. Maxi, M.D. City of Stockton <br /> William J. Wade Jopl Khanna, M.O., M.P.H., olalrkt Health Officer City of Tracy <br /> San Joaquin County <br /> Mary Anna Love San Joaquin County <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> 1 , the undersigned owner and/or opgrator of the property and/or facility <br /> located at /per <br /> O v <br /> hereby authorize o <br /> to release any and all analytical resul , geotechnfgal 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 /> Ownef/Operator: JiLto [�.y.� 7e Title: <br /> Address PD, 1 j pl( /alb/ Phone: 14Alt— ZLI1 <br /> Date: 17 <br /> Uf 08 05 UGT 13 <br />