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ISTF' - • P -1 = <br />bo'kAo or taustffs <br />SAN JOAOUIN LOCAL HEALTH DISTRICT <br />Pe1�1e1• Vann�cet. S•t'r <br />AntAonatta Van Sp.on,an 1601 East Har t <br />ton Avenue. P. O. $,z�9 San1pes:avtKa <br />E aft Ptnant.r CItr of c odl <br />quin <br />Gountr <br />F•.n a„ooaa Stockton, C211lornia 95201 <br />Oanlal L. Floews city f oof M c•tan <br />ant•C• <br />John 0, l�(aif. Ed.O, 204/46&5781 Ripon <br />fir o1 RiponWllffam J. Wada Cttr of Stockton <br />Ri <br />Mary Anna Love Jo91 Khanna. M.o,� M.P.Ff.. on <br />Of.talGf tfaal(h Oltlerr <br />city Of Teacy <br />San Joaquin County <br />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 •fact]tt <br />located at /"7� �f 1f, y <br />hereby authorize i <br />to release any and all analytieal results,rL:1r, �) <br />assessment information to the San Joaquin LocaleHealth l data and site <br />as it is available and at the same time it is provided O me of soon <br />representative. or myy <br />OrrneWperator: <br />° Title: <br />Address <br />e • Phone: ZIZ -,25� <br />If 08 05 v 'r 13 <br />