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IIOARO OF IRVSIEES <br />J•mef Culbertson, Pref. <br />P.Irlcl, E. Vannuccl, Sec y. <br />Anlhonetle Ven Sproneen <br />Earl Plmentel <br />Fern Bup000 <br />Daniel L. Florae <br />John 0. Most. M.D. <br />William J. Weds <br />Mary Anna Love <br />0 r <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1601 East Hacellon Avenue, P. O. Box 2009 <br />Stockton, Callfofnia 95201 <br />209/466-6781 <br />Jopl Khanna, M•0.. M.P.N., District Health Office, <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 <br />hereby authorize <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 JoaQuln County <br />City of Eacalon <br />City of Mantic, <br />City of Ripon <br />City of Stockton <br />City of Tfacy <br />San Joaquin County <br />San JoaQuln County <br />"A'( D 1988 <br />'LiNVIRONMENTAL HEALTH <br />PERMIT/SERVICES <br />.3-�cr Thr ae�.J 6��c Z", 11 Ze f^.%eOr� �J•$ ie/C <br />Owner/Operator: / , 6 d—` <br />Address /-)-0 Phone: 7-o — Fz ?— 3, c / <br />�'ll�✓ ➢� Car > �r2 � �2 z i <br />Date: j G —F <br />0 <br />EH 08 OS UGT 13 <br />