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SOARD of TAVStEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> Jamal Cufbonaon, Pref <br /> Clil <br /> Aalrkla tt VannSpr Secy 1601 East Hazelton Avenue, P. D. Box 2009 San Joaquin County <br /> of Lodt <br /> Anihonatla Von Spronaen y <br /> Fa City of E. Calon <br /> (�'`manlef 5lockton, California 95201 a <br /> Fa(. ,upUee C11y of Monlec <br /> Danfaf L. Floral 209/466-6781 Cily of Ripon <br /> Clly of$locklon <br /> John Q. Mut, M.D. City of Tracy <br /> William J.Wade Jopl Khanna, M.D., M.P.H„ Dlatrfcl Health Officer S■nJoaquli Counly <br /> Mary 4nna Lore San Joaquin County <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> I, the undersigned owner and/or operator of the�roperty and/or facility <br /> located at >'?,'/ (_cam: r cJ :�r.�1_ J, <br /> hereby authorize Canonie Environmental , Stockton, CA (209) 983-1340 <br /> to release any and all analytical results, geotechnical data and site <br /> :-ssment 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 /> j <br /> � r rept esentative• <br /> Owner/Operator: .Z�L epi+-`k ]i tl e: <br /> Addresses! <br /> +J�-,9�..,.�c�v s i" Phone: ��•-cam-<�[ <br /> i <br /> Date: 1��U� <br /> Ell 08 )C5 <br />