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"A, yr I'"' ` ' SAN'(JAUUIN LUCAL 11LAL i H 0151*1 <br /> • SLHVINO <br /> James Cult)"(130n. Pres. Chyotlodl <br /> PAIricis E Vannuccl. Secy. Sen Joaquin County <br /> Anlhonetle Van Spron3an 1601 East Hazellon Avenue, f. 0. Box 2009 City of Escalon <br /> ounty <br /> Earl Plmentel Stockton. California 95201 <br /> City of Manteca <br /> Farn Bupbee <br /> Oanlel L. Florey 209/466-6781 City of Ripon <br /> City of Stockton <br /> John D. Mast. M.O. City of Tracy <br /> William J. Wade Jopl Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br /> Mary Anna 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 p perty and/or facility <br /> zA <br /> located at1� �� <br /> hereby authorize .. �(l. l�c/ l<LO+�iZ lASSDCIT�S <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 /> Ownef/Operator: Title: <br /> — L� <br /> Address 2�0� .� Phone: <br /> Date: -/�—g`� <br /> a - <br /> EH 08 OS UGT 13 <br />