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BOARD TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> James Culbertson. Pras. SERVING <br /> Patricia E. Vannuccl, Secy. City of Lodl <br /> Anthonette Van Spronsen 1601 East Hazelton Avenue, P. O. Box 2009 San Joaquin County <br /> Earl Plmentel Stockton, California 95201 City of Escalon <br /> Fern Bugbee City of Manteca <br /> Daniel L. Flores 209/466-6781 City of Rlpon <br /> John D. Mast, M.D. City of Stockton <br /> William J. Wade Jopl Khanna, M.D., M.P.H., District Health Officer City of Tracy <br /> Mary Anna Love San Joaquin 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 2 L(S to C <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 /> Owner/Operator: ��1 �A�i�II, Title: 6)1erjgT6 e <br /> Address ZZ4 LU , ( u'I� Phone: 9 y/=�?-� <br /> Date: <br /> EH 08 05 <br />