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04 <br /> J41M 6c l,i 114 t) SAN JOAUUIN LOCAL HEALTH DISIHICT <br /> Jam.a t.U�lT«taon,pros. SERVING <br /> "t Mary Anne t.om Vice Prea. 1601 East Hazelton Avenue, P.Q. Box 2009 City of Lodi ' <br /> Patricia E.Vannuccl,6ec'y. San Joaquin County <br /> Tommy Joyco Stockton, CeHlornla 9S201 San Joaquir;County <br /> Earl Pimentel Ctty of Eacaion <br /> Vkglnla Mathews (209) 466-6781 City of Manleci <br /> Daniel L Flores City of Ripon <br /> John D.Most M.O. City of Stockton <br /> Gena 8. Krah■m J041 iChanna,:M.O,}M.P.H�Olahicl He■Mh OM{c.r City of Tracy <br /> San Joaquin County <br /> 4 <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> f <br /> I , the undersigned owner and/or operator of the property and/or facility <br /> . located at 6Gr) <br /> 6, 1 � _ <br /> hereby authorize <br /> to release any and all analytical results , geotechnical data and sites <br /> ` assessment information to the San Joaquin Local Health District as soon <br /> as it is available and at <br /> i .: the Same, time it is provided to met or my <br /> k representative . <br /> I <br /> OwneV/Operator : t^ <br /> "I'it1t� : <br /> i Ilclrirc ; ; ,2-4 �- <br /> Phone <br /> k <br /> i <br /> f <br /> 4: <br /> r <br /> };1( 08 05 U(i'I' 1 '3 ?a <br />