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10 or 111US1EES SA14 JOAUUIH LOCAL_ HEALTH LAS IRIC V SERVING <br /> Culbertson,Pres. City of Lodl <br /> .ry Anna Love.Vice Pr... 1601 Enet Hazelton Avonue, P.O. Box 2009 San Joaquin County <br /> .It�la E.Vannuccl.Secy. San Joaquin County <br /> 11 ly Joyce Stockton, California 95201 <br /> n City of Escaton <br /> Imentel <br /> City of Manteca <br /> (ginia Mathews (209) 466-6781 City of Ripon <br /> ,nlel L.Flores City of Stockton <br /> 4 D.Mast.M.D. Jopf Khanna.M.D.,M.P.1i.,District tissith otftcar City of Tracy <br /> s S.Kraham San Joaquin County <br /> AUTIIOIIIZATIO14 TO RELEASE ANAI,YTICAL 11ESULT3 , GI;OTECIINICAL IATA Arm <br /> SITE ASSESSMENT INFORMATION <br /> I , the undersigned owner and/or operator ofthe property and/or facility <br /> located at SF�/- <br /> L-hereby authorize <br /> f <br /> to release any and all analytical results, geotechnical data and site- <br /> assessment <br /> ite <br /> assessment infornlatioll to the ;3a11 .loagLtin Local health District as soon <br /> as it is available and at the .came time it is provided to rile or lily <br /> representative . <br /> Owner/Operator: _! i l�y�_15► >� �--- _'1'it1c� : �� Re .�G n, <br /> 23 3 �- <br /> Address - Gt�SrS•1,C9rn_VCc.J� �Lt_�1>honc� <br />