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C <br />Anthunatia Van SP(oneen <br />Earl f'imanlol <br />Farn BLpoee <br />Daniel L. Flores <br />John 0. Mast. M.D. <br />William J. Wade <br />Mary Anna Love <br />AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br />SITE ASSESSMENT TNFORKMON <br />I, the undersigned owner and/or operator of the property and/or facility <br />located at _ I'1.3 A/ 1ZdL)ly'i Sr � jp✓ 1-7C1� <br />hereby authorize <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 />c � C(V"' <br />Owned/Operator: %�i�5�1r9 jJ R�� <br />Title: <br />Address 1 °I :1 iC �� . ri u,/° a /Phone: <br />Date: <br />08 05 UGT 13 , <br />li�Ul <br />I .1;,1161/rllun AvCnu(), N O Bos /lhJ'J <br />C11 I wo, <br />`'an Joaquin County <br />Stockton, Calllofnia 95201 <br />City of Escalon <br />City of Munlrcca <br />209/466 6781 <br />Cily of RIPon <br />City of SIOCkion <br />Jogl Khanna, M.D.• M.P.N.• Diatflct 1/e• It O(flcu <br />City of Tracy <br />San Joaquin County <br />tl <br />San Joaquin County <br />AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br />SITE ASSESSMENT TNFORKMON <br />I, the undersigned owner and/or operator of the property and/or facility <br />located at _ I'1.3 A/ 1ZdL)ly'i Sr � jp✓ 1-7C1� <br />hereby authorize <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 />c � C(V"' <br />Owned/Operator: %�i�5�1r9 jJ R�� <br />Title: <br />Address 1 °I :1 iC �� . ri u,/° a /Phone: <br />Date: <br />08 05 UGT 13 , <br />