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aOAAO Or IAUSI((S <br />Jamal Cult/enlon. Plot. <br />P6111CIa E. vannuccl. Sac'y <br />Anlhonelle Van S0'onsen <br />( oil Plmentel <br />Fein (iuouee <br />Oanlef L. Flo(ea <br />John 0. Mast. M.O. <br />William J. wed. <br />Mary /Anna Love <br />0 • <br />SAN JOAOUIN LOCAL HEALTH DISTRICT <br />1601 East Hazelton Avenue. P. 0. Box 2009 <br />Stockton. Callfornia 95201 <br />209/466-6781 <br />Jogl Khanna, M.O., M.P.H., District Health O(flcw <br />AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br />SITE ASSESSMENT INFORMATION <br />S(RVINO <br />City of Lodl <br />San JoaQuln County <br />City of E scalon <br />Clly of Maniacs <br />City of Ripon <br />City of Stockton <br />City of Tracy <br />San Joaquin County <br />_,San Joaquin County <br />Q 64 <br />FEB , <br />ENVIROFOENTAL HEALTH <br />FERMIT/SERVICES <br />i. the undersigned owner and/or operator of the property and/or facility <br />located at o5;�--2/ <br />hereby authorize % -oma <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: )( v, u•��) Title: <br />Address �24Z ��2 � ��—� Phone: <br />ti <br />