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rfaa�o or tn�slEEs SAN J.WUIN LOCAL HEALTH DISTRI� SEAVINo <br />'.ro.� Cv1L•nson. P ... <br /> artct. E. Vanmvccl. S.Cy City of COW <br /> San Joa <br /> nlhonill• Van $pion..n 1601 East Hazelton Avenue, P. 0. BOR 2009 quln County <br /> .,I ►Im.nt.l Stockton, Calllornia 95201 Ccity of Escalon <br /> ly of M.nl.c. <br /> .,A 8upo.• <br /> antal L. Flo,.. 209/466.6781 City of Ripon <br /> ohm 0. Most. M.D. City of Slockton <br /> City of Tracy <br /> ory A <br />' J. W.d• Jopl Khanna, M.D.. M.P.H., Oblrld Nulth Offlc.r San Joaquin County <br /> •ry Ann. Lor• San Joaquin County <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS. GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> 1 , the undersigned owner and/or operator of the property and/or facility <br /> located at 1 %,:5� G A/ iBT1ZIfs !i r,��n/ re <br /> hereby authorize I l NLtLL f' ALM cr. Alc/"Tre c-i1 <br /> to release any and all analytical results, geotechnical data and site <br /> assessment infonnation 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. �fj <br /> Ornef/OptssEor: '1Jr %/����jiiLt/ Title: <br /> Address 1. 3 f' S Ti A F/ A'J C e ' // % Phone: ? -5 ,�L• i 7 <br /> Date: / / <br />