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SAh�JOAQUIN LOCAL HEALTH OISTCT <br /> Jle s eulbertaon. Pua. SERVINO <br /> f•lrlcla E. Vannuod, Sac'y . Gly of Lodi <br /> Mlhon*fle van apronaan 1601 East Hatelton Avenue, P. 0. Box 2009 San Joaquin County <br /> Ei1 mensmol Stockton, Callfornta 95201 City of Escaion <br /> Fath lvtlbos city of Maniacs <br /> Danlaf L Floc„ 209/466$781 Gly of Ripon <br /> John D. Maxi. M.D. Gly Of Stockton <br /> WWnam J.Wad* Joel Khanna, M.O., M.P.H.. District Haallh officer City of Tracy <br /> Mary Ann* Low M'� San Joaquin County <br /> P EGA EQ San Joaquin County <br /> R <br /> OFA �" g �g81 <br /> ��I PQ�ITSERVICES GZN <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> I. the undersigned owner air of the property and/or facility <br /> located at V,,4-C4-,co7'L07- <br /> hereby authorize [ S�oc�Tacl. <br /> _ ,r o Lc n� Lt_J n -{�' T ch n a l oG � <br /> to release any and all analytical results, geotechnical data and site <br /> assessment infoyulation 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/Operctor: G Title:'�7t7�, cT <br /> Address S- g Phone: <br /> Dace: <br /> r r <br /> EH 08 OS UGT 13 <br />