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BOARD OF 1RUS7EES SAH JOAQUIN LOCAL HEALTH DISTRICT <br /> James Gulbartson. Prel. SERVING <br /> Palrlcla E. Vannucci. Secy. Clly of Lodi <br /> Anthonefle Van Spronsan 1601 East Hazelton Avenue, P. O. Box 2009 San Joaquin County <br /> Earl Plmentel Stockton, Callfornia 95201 City of Escalon <br /> Fern Rupoee City of Maniacs <br /> Daniel L. Flores 209/466$781 City of Ripon <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 L' r1 /} <br /> ��'OJ c !1 � <br /> hereby authorize C-P� L"r. (2, , <br /> to release any and all analytical results, geotechnical data and site <br /> assessfnent 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 /> Ownef/Operdtor: � ` q��. , Title: CA c <br /> Address /GSX ria -y/��p�7 / %/j �/ Phone: <br /> Date_ 2r /9 -7 <br /> rNZ�= , <br /> /44 <br /> FFRM/�iSV/S4r <br /> Aj <br /> EH 08 05 UGT 13 a r <br />