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BOARD OF IRUS7EES SAf' IOAOUIN LOCAL HEALTH DISTRICT SERVING <br /> iambs Culbertson. Pres. " City of Lodi <br /> Patricia E. Vannuccf. Secy. 1601 East Hazelton Avenue, P. O. Box 29 San Joaquln County <br /> Anthonelle Van Spronsen 00City of Escalon <br /> Earl Plmentef Stockton, California 95201 City of Manteca <br /> Fern Bupbee 209/466-6781 City of Ripon <br /> Daniwi L. Flores City of Stockton <br /> John D. Mast, M.D. City of Tracy <br /> SNUfiam J.Wade Jopl Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br /> Mary A.;.oa 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 1(p SO 6f,4,1',V 5T S70e-kToI�j 64 - <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: —170M/ Ans Title: MAI`= <br /> Address !� 30 E • Gla'*yA'£/ Phone: V&Z.- <br /> G�Isc [C�•-a C�. 9saoS- <br /> Date: Zcy �B�o <br /> EH 08 05 UGT 13 a <br />