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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> James Culoen,on, Pre,. City of Lodl <br /> Patricia E. Vannuccl, Secy 1601 East Hazelton Avenue, P. O. Box 2009 San Joaquin County <br /> Anthonette Van Spronsen City of Escalon <br /> Earl Pimentel Stockton, Callfornla 95201 city of Manteca <br /> Fern Bupoee 209/466-6781 of Ripon <br /> Daniel L. Flores City <br /> oof f Stockton <br /> John D. Mast, M.D. City of Tracy <br /> William J. Wade Jopi Khanna, M.D., M.P.H., District Health officer Sen Joaquin County <br /> Mary Anne 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 1876 Country Club Blvd. , Stockton , CA <br /> hereby authorize Canonie Environmental , Stockton, CA <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: <br /> Address Z Phone: <br /> Date: — � <br /> EH 08 05 UGT 13 <br />