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1.n.. _ (..,11. I/l.•1 I'...f . Il l'1rr(1 <br /> ' ,f•.Il It 1. ( \'..\n,./.(I '... ' .fly of 1 Udl <br /> Anlhunelle Van Spronen 1601 (.--Is( 11.ticllon Aventio. 11. O. Box /(X)9 .`..n loagvin <br /> Counly <br /> f.rn OupU0t)6es <br /> E.rl fel Slocklon. Callfornia 95201 city of Eac•lon <br /> 0anlClly Of MenleCs <br /> John 1. Floret 209/466-6781 City of Ripon <br /> John O, M.71, M O. Clly of SIOCMIon <br /> Wfllf.rn J. Weds Jopl Khenns, M.O., M,P.H, City of Tree <br /> OIsf(lcf Health Officer y <br /> Mary Anne love Sen Joaquin County <br /> Sen Joaquin Counly <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> I . the undersigned owner and/or operator of the property and/or 'facility <br /> located at <br /> hereby authorize /I� /If�e/( <br /> to release any and all analytical results. geotechnical data and site <br /> assessment information to the San Joaquin Local Health District as soon <br /> as it is available and at the same time it is provided to me or my <br /> representative. <br /> Owner/Operator: � <br /> Title: &xv1w1k) <br /> ' ,� <br /> Address C'�, Phone: 797- `/Z2 - <br /> s 33 <br /> Date: <br /> EH 08 OS UGT 13 <br />