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.OMD Or INVS1l(S <br /> f•T.. Ce1V.n.0n. P(., SAN JOAQUIN LOCAL HEALTH 01$TRI <br /> P.IJU. E. V.nnvcci. S.C'r sLa VINQ <br /> Anthon.11. Van So,,,.., 1601 EASI 11"ellon Avenue, P. O. ©ox 2009 911'Of Lodi <br /> ( .,l Plm.M.l S'^Joa Quln County <br /> F.,n 8.,0b.. Stockton, Callfornia 95201 City of E,C•lon <br /> O.nl.l L. Flo(.. 209/4G6-6781 C"V of M.nl.c. <br /> John 0, Mail. M.O. CltYof Rlpon <br /> City of Stockton <br /> MaryWilliamA J. Love loQl Kh•nna, M.O., M.P.H., otafr1ct Health offlcw <br /> Mary Anna Love Gly of Trey <br /> San Joaquin County <br /> San Joaquin County <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS. GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> 1 . the undersigned owner and/or operator of the roperty and/or facility <br /> located at <br /> hereby authorize -2� ZZ <br /> to release any and all analytical results. geotechnical data and site <br /> assessment inforration 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 /> Owner/Operator: �� Q <br /> a, Title: <br /> Address t0 <br /> st�� Phone: ig <br /> `�3 <br /> R9922VZ 6JAN r <br /> ENVIROkIENTAL HEALTH <br /> FERMIT/SERVICES <br /> ill 08 05 UGI 13 <br />