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BOARD (= TRUSTEES SAN J67<QUIN LOCAL HEALTH D �y 1,, �'�+l7� SERVING <br /> James Cuioanson. Pres. City of Lodi <br /> Patricia E. Vannuccl, Secy . 17 7 San Joaquin County <br /> Anthonelte Van Spronnon 1601 East Hazelton Avenue, P. O. Box 2 DOA N Hlv r? 1 �,`"- City of Escalon <br /> Earl Pimental Stockton, California 95201 ENVIROMENTAL HEALTH city of Manteca <br /> Fern Buooee 209/466-6781 of on <br /> Daniel L. Flores PERMIT/SERVICES City <br /> oof f Stockton <br /> John D. Mast, M.D. City of Tracy <br /> William J. Wade - Jogl Khanna, M.D., M.P.M., 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%o acility <br /> located at PP// <br /> hereby authorize 2C <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 /> I <br /> as it is available and at the same time it is provided to me or my <br /> representative. <br /> Owner/Operator: ", /�C fid Title: 1z, <br /> Address / ' Phone: � f �3tC <br /> Date: �QZ= <br /> EH 08 05 UGT 13 <br />