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8OAn0 OF TRUSTEES SAN -JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> James Culbartaon, Pisa. City of Lodi <br /> 'Paiiiela E. Vannuccl, Set y. San Joaquln County <br /> 1601 East Hazelton Avenue, P. O. Box 20( <br /> Anthonette Ven Spronaen City of Eacnlon <br /> ' earl Pimenlel Stocitton, Catlfornia 95201 cur of Manteca <br /> Fain Supbae 209/466-6781 coy of Ripon <br /> Dania[ L. Flores Clly of Stockton <br /> John D. Mast, M.D. City of Tracy <br /> William J. Wade Jog] Khanna, M.D., M.P.H., Dlatrict 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/or facility <br /> located at Sao S �-t-L_' cy J�iY.l <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 /> Ownef/Operator <br /> Address Phone: .. <br /> ;t. Date: <br /> EH 08 05 UGT 13 ° <br />