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ffOt�if(1'vi THUSTEt.S SAN JOAOUIN LOCAL HEALTH DISTRICT <br /> Jams Cuibartaon, Praa .. SERVING <br /> Mary Anna Lore,Vice Pret. 1601 East Haletton Avenue, P.O. BOK 2004 City of Lodi <br /> Patricia E.Vannucci,sac•y. San Joaquin County <br /> Tommy Joyce Stockton, Callfornla 95201 San Joaquin County <br /> Earl Pimentef City of EsCalon <br /> Virginta Mathawa Z (209) 466-6781 City of Manteca <br /> Oanbf L Floret City of Ripon <br /> John 0.Mwt,M.O. ( Chy d Stockton <br /> Gene S.Kraham ' 'fob Khanna,U.0,MAH.,Obtrkit"earth OMcsr City of Tracy <br /> San Joaquin County <br /> I <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 <br /> hereby authorize <br /> to release any and all analytical results, geotechnical data and is to <br /> assessment information to the San Joaquin Local Ifealth District as soon <br /> as it is avai able and at the m time it is provided to me or my <br /> v <br /> representativ <br /> (finer/Operator: <br /> Ad(I r essPhone <br /> Da LC <br /> E11 08 05 UGT 13 <br />