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enusrtE= SAtt AQUIN LOCAL HEALTH DISTt T <br /> J,wHg Culpen"n. Prea- <br /> Patricla E. Vannwoct. Secy SERVING <br /> AA11hon"o vee spron"M 1601 East Hazallon Avenua..P. O. Box 2009 San Jo 9t)'01 Lodi <br /> Earl Pimantef aquln CkKmtr <br /> Ern swag. Stockton. California 95201 Gtr of Eacaton <br /> DanW L Fkw" / 1 $781 City of Manteca JoM 0, MuCity of Ripont, M.O. Gty of St <br /> W11440�J.wade oddon <br /> Mary Ilan&Low Jog,Khanr`t. M-o, M.P.H.. Dtairkq Heath, officer City of Tracy <br /> San Joaquin County <br /> San Joaquin County <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> [. the undersi n <br /> 9 owner d/or operator of the property and/or facility <br /> located at <br /> J <br /> hereby authorize <br /> i <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 /> 0 <br /> Ow net er ` <br /> / � fir' Title: <br /> Address r <br /> a Phone: <br /> Date: — <br /> I <br /> i <br /> i <br /> i <br /> - I <br /> I <br /> i <br /> H 08 05 11GT 13 I <br />