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BOARD OF TRUSTEES <br />James Culbertson, Pres. <br />Patricia E. Vannuccl, Secy <br />Anthonatte Van Spronsen <br />Earl Plmentel <br />Fern Bupbee <br />Daniel L. Floret <br />John D. Mast; M.D. <br />William J. Wade <br />Mary Anna Love <br />SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <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�Q���� <br />hereby authorize <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 />Owned/Operator:�l i7a Ti tl e:y� <br />Address ,©; Q �7;i�, Phone:3�' X5'35 <br />Date: 1,;2- — jot— 'J(-- c <br />ygczavzo <br />DEC 17 198b <br />ENVIROMENTAL HEALTH <br />PERMIT/SERVICES <br />EH 08 05 UGT 13 3 <br />City of Lodi <br />1601 East Hazelton Avenue, P. O. Box 2009 <br />San Joaquin County <br />Stockton, California 95201 <br />city of Escalon <br />City of Manteca <br />209/466-6781 <br />City of Ripon <br />City of Stockton <br />Jopl Khanna, M.D., M.P.H., District Health Officer <br />Cof Tracy <br />San Joequin 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�Q���� <br />hereby authorize <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 />Owned/Operator:�l i7a Ti tl e:y� <br />Address ,©; Q �7;i�, Phone:3�' X5'35 <br />Date: 1,;2- — jot— 'J(-- c <br />ygczavzo <br />DEC 17 198b <br />ENVIROMENTAL HEALTH <br />PERMIT/SERVICES <br />EH 08 05 UGT 13 3 <br />