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1 <br /> Anu-unwll• Van [+(�` ;SI l i uellun Avciiuq. P. O. B AKfj :an Joaquin Cuumy <br /> i <br />[•+I Plmenlwl tv SIOcklon, Call(orfsia 95201 ��Ir or Eac.fon <br /> •In Dupbwa City of Hamate ir <br />]•nlaf L. Flolw. 2W/466$781 Gtr of Ripon t <br /> City of Slocktoo <br />�or,n p, Mail. MD. City of irllCy � <br /> vllllarn J. Wade Jogl-Khanna, M.D.. M.p.H., Ofalrlcf !{awllh o(flc.r San Joaquin County <br /> � <br /> t•ry Anna Lor• San JoaQuln County <br /> I <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 -faci'lity <br /> located at �L.D( <br /> hereby authorize <br /> a _ <br /> to release any and all analytical results, geotechnical data and site <br /> assessment information to the San Joaquin Local He ' <br /> alth District as soon <br /> as it is available and at the same time it is provided to me or my <br /> representative. <br /> OwneF;Operator: <br /> Title: <br /> Address w ? n Phone: - 3S'- ;3 a o <br /> P �Z , <br /> Date: <br /> J W <br /> H 08 05 UGT 13 <br /> ,a <br />