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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRI �jrbAV En SERVING <br /> James Culbertson, Pres. ,,g�� Ity,of Lodl <br /> Patricia E. Vannuccl, Secy. 1601 East Hazelton Avenue, P. O. Box 2009 jU N � N','Joaquin County <br /> Anthonette Van Spronsen ' City of Escalon <br /> Earl Pimentel Stockton, California 95201 CItry f Manteca <br /> Fern Bugbee2094666781 ENVIROMENTAL HEALtty of Ripon <br /> Daniel L. Flores <br /> John D. Mast, M.D. FERM17/SERVIC88� Stockton <br /> City ofTcy <br /> William J. Wade Jogi Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br /> Mary Anna Love 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 /230 �jo. CC AlTRAL At/:: . ,LoO/ 0,4 , <br /> hereby authorize &jlr-, WAS 446S — I't'IODIFS70 , OA <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 /> Owner/Operator: Title: Q <br /> Address 1 Q30 Sn Phone: <br /> Date: 6 — 3— <br /> EH 08 05 <br />