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unv"I +/W/"9WB.{Iln 81 r-FLL 1 Cl L)I:21 tiIU I <br />�Jomoa culberlBon, ^rca. <br />r-710alf1cla E. Vannuccl, Secy <br />Anthonott© Van Spronaon 1 C aam B9,aaekon Ayunuo, P. CO. Boy, 200- <br />Earl Pimontel uBcDchBon, GaffBornia 95201 <br />+ Forn L'uobao e <br />Daniol L. Flores 201466-6701 - <br />John 0. Mael, M.D. <br />William J. Wade Joel I(hannn, M,0_ N.P.H., DIntrict finaith Officer <br />Mary, Anne Lova <br />11VKo <br />AUTHORIZATION TO RELEASE ANALYTICAL RESHL`I:SoGEOTECHNICAL DATA AND <br />SITE ASSESSMENT INFORMATION <br />1, the undersigned owner and/o1• opcarzjrttc aa5' thi? property and/or facility <br />located at <br />hereby authorize <br />to release any and all analytical result:=,;,cyeotechnical data and site <br />dssessment information to the San',lnaquin Local Health District as soon <br />as it is available and at the Same time itis provided to me or my <br />representative. ,�7 Q <br />EV <br />Owner/Operator: <br />Title: <br />AddressE�9 6 hone: 3 6if S7S l <br />Date: ML30—�4 <br />DEC 01 1ytfb <br />ENVIROMENTAL HEALTH <br />FERMIT/SERVICES <br />EH 08 05 UGT 13 <br />SERVING <br />Clty of Lodi <br />San Joaquin County <br />City of f acalon <br />City of Manteca <br />City of Ripon <br />City of Stochton <br />City of Trncy <br />San Joaquin County <br />San Joaquin County <br />f <br />