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BOARD OF' TRUSTEES <br /> J.n...GrrbM.a,ti F..�. SAOJOAOUIN LOCAL HEALTH DISTROT <br /> MW7 A" Low*Vbm h� 1601 Easl►1sxelton Avsnu�,P.O. Box 2009 SERVING <br /> ►sbld,c vannucck 3�y. `. s... city a Lodi <br /> Jopu{, <br /> TO--y' Stockton,CalHomis 95201 '�'q"1^ <br /> Ectal/bn«.*"W W <br /> vii w mmh. ea Cky M[+cJen <br /> DaniN L Flo.ta (209) 166-6781 city W MW4 <br /> JoAn D. mM.D Joel KK ..M.D-WPM-Dbblcl Mia DIM1c. ., _ - �SlCky ALP"b <br /> K, <br /> S. ah ^ <br /> Gene am cMy b Tracy <br /> San Joa q�in Cprnly <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS , GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> 1 , the undersigned owner and/or operator of the property and/or facility <br /> located at S . MAC AWM p` ptilVt <br /> -%IzAc! cauV--i,Pltiq <br /> hereby authorize ml(Y (- L&9 <br /> HAN La)�e <br /> to release any and all analytical results, geotechnical data and site <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 /> Owner/Operator: <br /> -- ��� ��fl �` CQ 117�y°Title: �I>?(C11tJNFnrnm A ` IM1►' <br /> Address - tZ}� <br /> Phone: SgI43�Z_-1103 <br /> _ C�P-r�MFIv'� ( A 9�1D91 <br /> Date: <br /> EH 08 05 UGT 13 <br />