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R6AHD of IRUSIIts • <br /> !a'*-er CulUan aUn, •(( <br /> SAN JOAQUIN LOCAL HEALTH UISTF#� <br /> Praa <br /> Petrlcla E. Vannuccl Sac•y SERVING <br /> Anlhonnile Van Spumiun 1601 Fast Halellon AY City of Lodi <br /> Earl Plrnanlal Avenue, P. O. Box 2(KJ9 San Joaquin County <br /> Fern 6upuee Slneklon, California 95201 Cltyol Escalon <br /> Daniel L. Flores 209/466-6781 City of Manteca <br /> John D. Mast, M.D. City of Ripon <br /> William J. <br /> Wade J091 <br /> of Stockton <br /> Miry Anne Love Jo171 Khanna, M.D., M.P.H., District Health Ofllcer City of Tracy <br /> San 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 �property and/or facility <br /> located at 13613 N <br /> hereby authorize <br /> to release any and 1 analytical results, geot6iEhnical 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 /> Owned/Operator: <br /> Title: <br /> Address Phone: Coy) <br /> N 41 <br /> Date: <br />