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BOARD Or IRVSIEES SAIIJOAQUIN LOCAL HEALTH DISRICi <br /> James Culberlaon. Piea. SERVING <br /> Patricia E. VSnnuccl• Secy. City of Lodi <br /> Anlhonetle Van Sptonaen 1601 East Hazelton Avenue, P. 0. Box 2009 San Joaquln County <br /> Earl PlmentelFern Stockton. California 95201 city of Eacalon <br /> Dani ll upoae Daniel L. florae 209/46"781City of MantecaCity of Ripon <br /> John D. Mael, M.D. City of Stockton <br /> William J. Wade Jopl Khanna, M.D., M.P.H., District Haallh Officer City of Tracy <br /> Mary Anna Love San Joaquin County <br /> San JoaQuln 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 /S�OCKTON �D` I Q6�a <br /> hereby authorize <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 /> Owned/Operator. Title. �y ,gyp <br /> Address A.O gAp �le� Phone: 3lG_ �lU 3 <br /> Date: Z� �04� � oe�cp,J �� • ys,c�� �� sS/ <br /> RECEIVED SEP 2 8198T <br /> OCT 5 9987 <br /> ENVIROMENTAL HEALTH <br /> FERMIT/SERVICES <br /> EH 08 05 UGT 13 <br />