Laserfiche WebLink
t <br /> t+c}4 tau Or t +tu,tt t s "AN JOAQUIN LOCAL fflFAt TPi ()I(; i fIIC;T <br /> t,rs Cul;,rut%ton, 1'ip� SEFtv1h0 <br /> �'&I"r Erw, .'wnnir�Cl �nC y <br /> ( <br /> Anuu <br /> � r,„rte van ` , , f•.rrn 1f'O1 r,t;f ff,tlr•!i{�n Cai'nt10, F' O City of ()d: <br /> Jna f?ray 'Ck;�l �.,r, <br /> n,l PI,rir,rrTn1 qulnC.�, n I} <br /> `)Ir,(:klon, Cailf()rma �P,'101 City of F5cmion <br /> F ern ESut Uen Clly of Manteca <br /> Danlef L. Flores 209/466-6781 Clty of Ripon <br /> John D. Mast, M.D. city of Stockton <br /> William J. wade Jog( Khanna, M.D. M.P.H.. 0181FICt finalth Officer City of Tracy <br /> Mary Anna LoreSan Joaquin County <br /> San Joaquin County <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS , GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> I , the undersigns weer d/or operator of the property and/or cility <br /> located at --5T-: <br /> hereby authorize <br /> fey <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 /> Owns Aerator: / <br /> Title: � <br /> Address r` <br /> Phone: <br /> Date <br /> JAN 13 P117 iU 'G80 <br /> ENVIHUMLviTAL HEALTH FNVIRUMENTAL HEALTH <br /> PERMIT/SERVICES E ER IA I T/SERVICE,S <br />