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t <br /> 'SOA°D OF r°WaES S` JOAOUIN LOCAL HEALTH DIICT <br /> James Culbertson, Pros. <br /> Patricia E. Vannucc(, Secy. City of Lodi <br /> AnthonMts Ven Spronsen 1601 East Hazelton Avenue, P. O. Box 2009 San Joaquin County <br /> EM Plrnentei Stockton, Callfomla 98201 city of Escabn <br /> Fern Suebse City of Manteca. <br /> Daniel L. Flores 209/486-6781 City of Ripon <br /> John D. Mast, M.D. City of Stockton <br /> William J. Wads Jopi Khanna, M.D., M.P.H., District Health Offlosr City of Tracy , <br /> Mary Anna Louse San Joaquin County <br /> 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 property and/or facility <br /> located at _ � Eases l bz it% .�o:&W1 <br /> hereby authorize /,,-e/ -6L-a, <br /> to .release any and all analytical result , 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: Title: <br /> Address &-0-749, 2 J Phone: <br /> Date: OF <br /> 08 <br /> ENVIROMEWAL HEALTH <br /> PERMITI <br /> i <br /> EH 08 05 <br />