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RoARb of IRU51EES SA#OAQUIN LOCAL HEALTH DIST IICT <br /> Jsms$ &IDarlson. fres. SERVING <br /> Palrlcla E. V&nnuccl. Secy. Clly of Lodi <br /> Anlhonetle Alan Spronsen 1601 East Hazelton Avenue, P. O. Box 2009 San Joaquln County <br /> End flmenlel Stockton, California 95201 city of Escalon <br /> Fern BuQDee CRY ofManteca <br /> Psnlei L. Flores 209/466-6781 City of Ripon <br /> John D. Mast„ M.D. City of Stockton <br /> W1111am J. Wade Jogf Khanna, M.D., M.P.H., Dialrici Health Officer City of Tracy <br /> Mary Anna Love Sara Joaquin County <br /> 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 property and/or facility <br /> located at / �j 1 - „/ �t SA Z?d <br /> hereby authorize <br /> to release any and all analytical results , geotechnical data and site <br /> dssessment information to the San Joaquin Local Health District as soon <br /> as it is available and at the saltie time it is provided to me or my <br /> representative. <br /> i <br /> Own4/Operator: Title: <br /> Address ' s I )L Im .r� 5 6� _Phone Q05 <br /> Date. <br /> I !I oF3 os il("T 13 <br /> JIB <br />