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DOARO OF TRUSTEES SAN _ AQUIN LOCAL HEALTH DISTR. SERVJNG <br />/•m.e Cu1beA•on,R,«. <br /> City w Lodi <br /> Mary Anna j*".voce Pr.•. 1601 East Hatefton Avenue, P.O. 110K 2009 San Jo.q,4n County <br /> relAele E.vne cl, 6ec'y.VcSan JwquMt County <br /> T•n•n► "t*4 Stockton, Cnfltofnla 95201 Cit,w�xy�t <br /> E•A►ImenlN <br /> Vlrpinta Math•"` (209) 4r,6-6781 City of M•nl•c• <br /> O•nMl L FIw.. <br /> CKy of Ripon <br /> Jam D.MatA,M.O. JoQI Khw-w.M.O,M.f.R.,D44"fie nyt Of%c« Ch1'tt Stockton <br /> c+h of Tracy <br /> O.rte 0.Knh•m San Joaquin Ceunh <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> I , the undersignedowner and/or operator of the property and/or facility <br /> located at <br /> 4iereby authorize <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 . �T <br /> Owner/Operator: t\JC -'� Title: 2 ►2lZW� <br /> Addressf1iL16�, A AA ¢,-f Rhone : <br /> Date : <br /> Ell 08 05 UGT 13 <br />