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. SW113 rT 3-2 <br /> k u r I <br /> t39ARp Of TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVINO t ' <br /> Jerna! Culban3on, Prey osquin County <br /> Vannuccl Secy Cit ut Lodi <br /> ina <br /> r' <br /> n elt E� <br /> le Van Spronaon 1601 851 Ha2BllOn AV$nUP3, P 0 Ox 2[;a9 San JCllyof Escrion <br /> ■rl Pimentel Slorkton, Caliiornla 95201 City of Manteca <br /> ern 9ugose , <br /> Cny of Ripon <br />)ante+ L Flores 209/466-6781 # <br /> john Q Mast, M D City of Stockton <br /> City of Tracy <br /> Y11liam S Wade Jogl Kkanna, M 0 . M P H District Health Officer San Joaquin County <br /> dory ,nna Lora San Joaquin County <br /> 4 I <br /> alt <br /> 1 <br /> rl=. <br /> t vW <br /> s ry <br /> AUTHORIZATION TO PELEASE ANALYTICAL RESLILIS , GEOTECHNICAL DATA AND >' <br /> SITE ASSESSMCNT INFORMATION r` <br /> F, <br /> I , the undersigned owner and/or operator of the property and/or facility <br /> located at X03 "3 Pilgrim, Stockton , CA <br /> hereby authorize Canonie Environmental. Stockton, CA _ Y <br /> 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: i Title: <br /> Address `, ,f' r r' 1 -- Phone. ,a <br /> Late <br /> ` I <br /> ~ <br /> f <br /> t <br /> t A+I <br /> C P ria nr !tr 'i <br />