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i <br /> BOARD TRUSTEES <br /> James Culbertson. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> bertson, Pres. SERVING <br /> Patricia E. Vannuccl, Secy. City of Lodi <br /> Anthonelte van Spronsen 1601 East Hazelton Avenue, P. O. Box 2009 sen JoaQuln county <br /> Fern Plmenlel LStockton, California 95201 City of Escalon <br /> Daniel L. Flo <br /> Fern B . Flo City of Manteca <br /> Flores 209/466-6781 City of Ripon <br /> John D. Mast, M.D. Clly 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 yyy� Ri.ePe T �,1,g , STocKrr� f ChC , � <br /> hereby authorize CSA&Io,y 1 t ,Alc—p , AJ 4 <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 /> ©lftr-�K 44 69, Co , <br /> L�a� - <br /> Owner/Operator: Title: <br /> Address �ilZ Fb/Z7' Phone: <br /> � -0 A) �A <br /> Date: 5—G <br /> EH 08 05 <br />