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BOAR00F IRUSI EES SAN*AQUIN LOCAL HEALTH DIST Rq sERvfN0 <br /> • Jfinef Culbertson, Pref. <br /> ralrlda E. VacnuccCIIY of Lodi <br /> l. Secy. 1601 East Hazellon Avenue, P. O. Box 2009 Sen JoaQuC <br /> ln ounty <br /> Anthonelle Van Spronsen City of Escalon <br /> Earl Plmenlel Stockton, Calllornia 95201 City of Manteca <br /> CityoFeinClly BuVbee 209/466-6781 City <br /> Stt Ripon <br /> Danlel L. Flores ockton <br /> John D. Most, M.D. City of Tracy <br /> rVllllam J. Wade Jopl Khanna, M.D., M.P.H., District Health Officer Sen Joaquin County <br /> -.Lary Anne 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 goo E WC)oi) �l- ID%5� I��, Woo0(90t06ge'.'a <br /> hereby authorizeyToc �CzCJ�+J_�cn� r �+r � T10.� <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 /> wooDlT,eln41% (,eLF - eef..,4ry c- L4 <br /> Owner/Operator: Title: GfN• MMI <br /> Address p , p Phone: <br /> ,.v. <br /> Date: z�d 8' <br /> CH 08 05 UGT 13 , <br />