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E iAustirla SAN JOAQUIN LQCAL HEALTH•DIS'TRICT' <br /> CvIbeelfon• Praa ; SERVING <br /> fICla E, Vannucel• soc,y City of Lodi <br /> Ari Salle Van SP+onion <br /> ', <br /> 1601,East Hazelton Avenue, P. O.,Box 2009 San Joaquln County } <br /> Ea nsnjel Slocklon, Call-fornia 95201 city of facaton. <br /> F.arn evQDef City of M4nleCa <br /> 3:anlel L. Flores 209/466-678>I City of Ripon <br /> John D, 1Masl, M.D. City of Stockton <br /> Nlfllant J. Wade Joal Khanna. M.D•� M.P.M.; DfalticllHealth officer City of Tracy ` <br /> Mary 4nns Love San Joaquin County <br /> San Joaquin County- <br /> If. <br /> AUTHORIZATION TO RELEASE ANALYT1CAL- _RESULT'S, GEOTECHNICAL DATA, AND_=° I <br /> SITE ASSESSMENT' INFORAATI4N <br /> E 1 , the ondersigned owner and/or :operator of the property and/or facility <br /> C located as 2150 E. i Fremont Street, Stockton, CA' a• <br /> f <br /> hereby authorize Canonie Environmental , Stockton, CA, .983-1340 ' <br /> a <br /> to release any and all analytical results ,. geotechnical data and site. <br /> i <br /> ;{ ''sessment information to the San Joaquin Local Health District as soon - <br /> as it is available and.. at the ~same time :it i5 provided to me or my <br /> �3 representative. <br /> r <br /> Owner/Operator: Title: .Cf-.j rJ <br /> ` Address' —►cam oma' S Phone: e_,,'j X1-1-3 - :3c-c-.) <br /> Date: r 99, <br /> i <br /> iNos os UGf 13 <br />