Laserfiche WebLink
G <br /> s . <br /> BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT l <br /> City lyolof Loodd <br /> i <br /> James Culbertson,Pre$. Son Joaquin County <br /> Mary Anna Love,Vke Pres. 1601 East Hazelton Avenue.P.O.Bax 2009 San Joaquin County <br /> Pafri,�la E Vannuccl,Sec'y. City of fscalon <br /> Toxf ,Joyce Stockton,Cal3fomia 95201 �y of Mrnleca <br /> Fro .•nentel (209)466-6761 City o:Ripon <br /> Virginia Mathews City of Stockton <br /> Daniel L FloresCity of Tracy <br /> John D.Mast,M.D. Jogl Klwnna,M.D.,M.P.N,Dislrid Health officer San Joaquin County <br /> Gene S.Kraham <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 3.Z D w, j-1;7B,i/2 f7`d c_-7d A) <br /> hereby 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. <br /> f <br /> Owner/Operator- 441 am,/a" Title: <br /> Address ?ka W Phone: /Z 31 <br /> Date: Z3 <br /> EH 08 05 UGT 13 <br />