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sOA1110-01F TRUSTEEs <br /> SAN WAOUIN LOCAL HEALTH OISTRi�W SERVING <br /> Jam"creodaw%PIS& City o1 Lath <br /> Mary AW0104%alba►w+. 1601 East Hazelton Avenin,P.O.Box 2009 San Joaquin co," <br /> ►abicia!Vannrock See-1. San Joaquin Cwa ft <br /> To"Inv.Myon Stockton.CaNlomia 95201 Gti of locaMw <br /> Ead rbronlai <br /> vagini.mmem"Ws (209)466-6781 �a `a <br /> Oaniai L Floes Ca slocMon <br /> John O.Mask M.O. Jogs Khanna.M.O,M.►.H'Oiew""*am Officer D <br /> Gens S.Kraham CMy M Tracy <br /> oapuM County <br /> 1 �' �flCP <br /> ENVIROMENTAL HEALTH <br /> PERMIT/SERVICES <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS. GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> 1. the undersigned owner and/or operator of the property and/or facility <br /> located at S, i 6 ' F <br /> hereby authorize ftl <br /> to release any and AT analytical results, geotec nical data and site <br /> assessment inforslation to the San Joaquin Local Health District as soon <br /> as it is available and at the same tfine it is provided to me or my <br /> representative. <br /> Owner/Optrator: <br /> Title: � <br /> Address _ J Phone: meq_ 33 Si-�SCo <br /> d <br /> Date: <br /> EH 08 05 UGT 13 <br /> i <br />