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s6ARo of t:"kustEES SAN JOA-QUIN LOCAL HEALTH DISTRICT SERVING J <br /> James Cu IDeneon, Pies. • City of LOW -* <br /> Px'IfOr E. Vannuccl• soc•y. 1601 East Hazellon.A enua, P. O. Box 2DO9 San Joaquin County ,.. i�•i' <br /> City of Escabn <br /> Anthonetle Van Spronsen _ <br /> Eiri Plmanlel Stockton, California 95201 City of Manteca <br /> Cit�Farn SuobCity 209/466-6761 yof Stt Ripon <br /> ".Danlel L. Flores ockton <br /> •John D;Mast, M.D. - City of Tracy <br /> ..Wilflam'J. Wade Jool Khanna, M.D., M.P.H., DIalrlci Hoal(h Otllcor San Joaquin County <br /> San Joaquin County --` <br /> Mary Anna lore - <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 4907 E WATERLOO ROAD, STOCKTON CA <br /> hereby authorize <br /> to release any and all analytical resilts , geotechnical data and ite <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 /> 4 4j <br /> Owned/Operator: cru a Title: <br /> Address #207 cJa -&O ecC - Phone: /�3/ ' 3 <br /> V4d 9� <br /> Date: <br /> .F <br /> _ d <br /> it <br /> 1 4 <br /> EH 08 05 UGT 13 <br />