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OF iliusSAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 6 <br /> Jaamesures CulDenson. Pfes. SERVING <br /> Patricla E. Vannuccl, Secy. City of Lodl <br /> Anthonelte Van Spronsen 1601 East Hazelton Avenue, P. 0. Box 2009 San Joaquln County <br /> Earl Plmentel Stockton, Callfornia 95201 City of Escalon <br /> Fern BupDee City of Manteca <br /> Daniel L. Flores 209/466-6781 City of Ripon <br /> John D. Mast, M.D. City of Stockton <br /> William J. Wade Jopl Khanna, M.D., M.P.H., District Health Officer City of Tracy <br /> Mary Anne Love San Joaquin County <br /> San Joaquin County <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND / �q �2 <br /> SITE ASSESSMENT INFORMATION �-U/ IP <br /> I , the undersigned owner and/or operator of the property and/or facility <br /> located at <br /> hereby authorize /L f�,�`2/� <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 /> Owned/Operator. 4 `S Z/fr/ 1(14 itle: <br /> Address 23,5— �2f. /y/l!i/v"� Phone: <br /> /I/ Q /2 <br /> Date: <br /> FFR 1 <br /> ENVIROIVMENTAL HEALTH <br /> F ERMIT/SERVICES <br /> EH 08 05 UGT 13 <br />