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t", It I <br /> L J 1 C A t <br /> Yl� <br /> h Uri a I 10 Van SO a(I I iA1C!1(.m A <br /> pirtiontal . I �Y-1. -�A, <br /> [Jug 1)450 SIOCklon. Cajjjornitj 9!-4,01 <br /> . I i—i . — -- ..- (. CUF. <br /> 1;Y , 3ca:un <br /> City OF P-1hilloca <br /> 0. ma3t, 1d.p. city of Ripon ln <br /> J. yeade joul Khanila.. WPM- Diallict Manift] offIcar CItY 01 SlDckion <br /> Atins Lora <br /> C111 of Tracy <br /> Hi ALTRI Joaquin counly <br /> CES <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECIINICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> I. the Undersigned owner and/or operator of tijt� prope,,ty and/or 'facility <br /> located at 0 <br /> L <br /> hereby ? <br /> authorize <br /> to release any and all analytical results, <br /> hilical data and site <br /> assessment information to the San Joaquin Local Health District as <br /> 6S it is available and at the same it is provided to in <br /> F-epresenta ti ve. r! 0 r my <br /> 0,ine�/Operator: <br /> Title: 4 <br /> ----------- <br /> Address �--�. <br /> Date: <br /> "A <br /> AL HEALTH <br /> .1 Effiv]IT/SERVI CES, <br /> 68 05 UGT 13 <br />