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eOAlao Or IkUSILtS SA00AQUIN LOCAL HEALTH UIVICT SERVING <br /> Jame,-Culberl,on, Plea. City of Lodi <br /> Patricia E. vannuccl, Secy. 1601 East Hazelton Avenue, P. O. Box 2(X19 San Joaquln County <br /> Anlhonelte van Swonsen City of Escalon <br /> Earl Pimentei Stockton, California 95201 City of Manteca <br /> Fern Bupbee 209/466-6781 City of Ripon <br /> Daniel L. Flores City of Stockton <br /> John D. Mast, M.D. City of Tracy <br /> William J. Wade Jopl Khanna, M-D., M.P.H., District Health Officer San Joaquin County <br /> Mary Anna Love 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 :fk�E 21 c ziq,*„i /-Aa,r Cefo.v 57 o d r C <br /> hereby authorize C/4A10 f;z e—'kU/EbVrP?Ev7AL S £'✓icFs Co PO <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 /> Owned/Operator: Title: e u R,v <br /> Address ��� / � � / Phone: , 1'�l 5G3�— /, <br /> CA <br /> Date:— <br /> a <br /> EH 08 05 UGT 13 <br />