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troARb ul tR ,,. P,, S*OAOUiN LOCAL HEALTH DISWICT <br /> - .lamer CulUen son, Prea. <br /> Pairtcla E. Vannuccl, Secy. SERVING <br /> Anlhonette Van Spron,en 1601 East Hazellon Avenue, P. Cl. Box 2009 SanJoaQ inCOf <br /> oun yl <br /> Earl Plmentel <br /> Fern Bupoee Stockton, California 95201 Cilyo(Escelon <br /> Daniel L. Flores 209/466781 City of Manteca <br /> John D. Mast, M.D. City of Ripon <br /> William J. Wade City of Stockton <br /> Mary Anna Love Jo01 Khanna, M.D., M,P,N., District Health Officer City of Tracy <br /> Sen Joaquin County <br /> San JoaQuln 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 - I <br /> hereby authorize T�/v <br /> to release any and all analytical results, geotechnical <br /> te <br /> assessment info enation to the San JoaquinLocalHealthDistrictata das 'soon <br /> as it is available and at the same time it is provided to me or my <br /> representative. <br /> Owner/Operator: <br /> Address Title: <br /> ,te. �e Phone: S 97 - mss <br /> tr)ds51irn <br /> Date: <br /> 111 08 05 tI(J 13 ' <br />