Laserfiche WebLink
fIT ". I <br /> 80ARD {j`F iRU5IEE5 SAN PAQUIN LOCAL HEALTH DIST* SERVING <br /> Jxm)y Culbanson. Pros. City of Lodi <br /> Fafrtcia E. Vannuccf, SecDox 200"9 County <br /> y, 6U t Ec35t Hazelton AVenUo, P. 0. <br /> Jlnthonelte Van Sen Joaquln <br /> S Cit of Escalon <br /> .. P(omen Y <br /> �, E.rl pirnanlef Stockton, California 95201 City of Manleca <br /> Fern Bugbee209/465-f�781 City of Rlpon <br /> Daniel L..Flores City of Stockton <br /> John D: Mast, M.D. <br /> City o[7.�cy <br /> William J. Wada Jo®i Khanna, KD„ M.P.H., Dlatrlct Hoalth officer San Joaquin County k <br /> Mary Anna Love San Joaquin County <br /> rK., <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS , GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INrOQ.MATION <br /> I, the undersigned owner and/or operator of the property and/or facility <br /> located at p _ <br /> hereby authDrize � <br /> 6' <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 /> Owne -JOperatar- Title: <br /> Address ytip Phone: -y� o G �cf <br /> 0, d <br /> Date- Y3 <br />.a <br /> s <br /> , d <br />