Laserfiche WebLink
'S <br /> 130ARD of TRUSTEES <br /> pre%. SAN JOAOUIN LOCAL HEALTH INSTRICT <br /> James Culbertson,Pres, • <br /> Mary Anna Love,Vke Pres. SERVING <br /> Patricia I°Vannucci,stc•y. 1601 East Hazelton Avenue,P.O.Box 2009 City of Lodi <br /> 1.:. '1 y Joyce San Joaquin County <br /> finenlel Stockton,California 952(11 San Joaquin County <br /> Virginia Mathews City of Esealon <br /> Daniel L Flares (209)466-6781 City of Manteca <br /> John D,Mast,M.D. City of Ripon <br /> Gene S.Kraham Jogi Khanna,M,D,,M.pjj„District Heaflh Otrctr city of Stockton <br /> City of Tracy <br /> San Joaquin County <br /> AUTHORIZATION 'TO RELEASE ARAI-YTICAL RESULTS. GEOTECHNICAL <br /> SITE' ASSESSMENT INI-0RMATION DATA A110 <br /> I, the undersigned owner and/or operator of the Propert <br /> located at ,ro0 Err( Y and/or facility <br /> herebyauthorize Tic CA- <br /> to release any and all analytical. restrge <br /> lts <br /> assessment information to the San JoaquinLocal He <br /> as <br /> chnicadata and site <br /> as it is available and at the same time it is District as soon <br /> representative_ AOr_z _. Provided to me or my <br /> f1 / �l1/vrM•�/ /d r� <br /> ��ner/Operator: � )Z-c. <br /> L 'To::2ic vry �' z� Title. <br /> Address <br /> Phone: itis-1 3 - <br /> Date: — <br /> iC7x/dTv <br /> Eli 08 05 UGT 13 <br />