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UOARp Of tausfEES SA UIN LOCAL HEALTH DISTOO SERVING <br /> James l'uttGerSsun. Pres. City of Lodl <br /> Patrlcks E. Vannucel. Secy 1601 East Hazelton Avenue, P. 0. Box 21X19 San JoaqulnCounfy <br /> Anlhonette Van Spronsen City of fscs;on <br /> Ear! Plrnentel Stockton. Callfornia 95201 City of Manteca <br /> Fern Buvee 209/466-6781 City of Ripon <br /> Daniel L. Flores City of Stockton <br /> John D. Mast, M.D. City of Tracy <br /> ,N wam J. Wade Jo9I Khanna, M.O., M.P.H., District Health Officer San Joaquin County <br /> Mary Anna Love San Joaquin 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 er_Q( 42S T(TA <br /> hereby authorize �E(bl f �._ - <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 /> /6 Owned/Operator: Title: <br /> _ <br /> Address Phone: 'f <br /> �-� �" ���" , ���t�� ��at,��;._ �,:,�.- _�;;, , <br /> Date: <br /> fH on 05 UGT 13 <br />