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SA( AOUIN LOCAL HEALTH DIS SERVING <br /> GM+aen son. Prea. _� Ctty of LOW hnnucCl. Secy. <br /> Anlhonelle Van Spronsen 1801 East Hazelton Avenue, . Q. SOX 2009 San Joaquin County <br /> Earl Pl,nentel Stockton. California 95201 City of Escaloa <br /> Fern BuQt)ee City of Manteca <br /> Daniel L. Flores 2D9/466-6781 City of Ripon <br /> John D. !utast, M.D. <br /> City of Stockton <br /> City of Tracy <br /> William J. Wade Jogl Khanna, M.D.. M.P.H., Wait ct Health Officer San Joaquin County <br /> Mary Ann■ Love <br /> San Joaquin County <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEO ECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> I , the undersigned owner and/or operator of the property and/or facility <br /> located at Q r QJ <br /> hereby authorize r - 1 <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 salve time it is provided to me or my <br /> representative, <br /> Dwne� Operator_ (-I- CO l' S Title: (DL-6Y-,,0 lr <br /> Address . L Phone: f' <br /> Date: J -- <br /> EH 08 05 UGT 13 <br />