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•OARD OF IAUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT <br />Jamea CUlpartaon, Pres. <br />Patflcta E. vannuccl, Secy <br />Anlhonetie Van 5pronson 1601 Easl Hazelton Avenue, P, 0. Box 2009 <br />Eirf Pimenlel Slockton, Call Iornia 9ri201 <br />Firn Bugoeo <br />Daniel L. Flores 209/466-6781 <br />John D, Mast, M.D. <br />I <br />William J. Wade Jogl Khanna, M.D., M.P.H., District Health Vflcer <br />Mary 4nna' Cove <br />AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br />SITE ASSESSMENT INFORMATION } <br />i; <br />i <br />I, the undersigned owner and/or operator of the property and/or facility <br />located at" <br />„ 23675 S. Airport Way, Manteca., CA_ <br />hereby authorize Canonie Environmental, Stockton,__CA_ 983-1340_ <br />to release any and all analytical results, geotechnicaldata' 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 provideda <br />representative. <br />11 <br />I! <br />Owner/0 erator: �� �� LTi tl el: <br />Address j3 5 f r Phone: <br />/ n <br />it A' ! --.4- C7 <br />Date:;�'4f_ <br />EH 08 05 UGI 13 <br />me or my <br />SERVING <br />City of Lodi <br />San Joaquln County <br />City of Escalon <br />City of Manteca <br />City of Ripon <br />City of Stockton <br />City of Tracy <br />San Joaquin County <br />San Joaquin County <br />