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BOARD OF TRUSTEES SAtt-JOAQUIN LOCAL HEALTH DIS10ICT SERVING <br /> James Culbertson, Pres. <br /> Petrlcla E. Vannuccl, Secy. San Joaquin ty of ) <br /> in County <br /> -Anthonette Van Spronsen 1601 East Hazelton Avenue, P. O. Box 2009 <br /> City of Escalon <br /> Earl Plmentel Stockton, California 95201 City of Manteca <br /> Fern Bupbee 209/466-6781 City of Ripon <br /> Daniel t. Mores City of Stockton <br /> John D. Mast, M.D. City of Tracy <br /> William J. Wade Jopi Khanna, M.D., M.P.H., 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 a'ndj/or faciility <br /> located at 03 Wov' ' tL fYtel — Brock Tow Co . -� <br /> hereby authorize J� P. K I efi tri V PI ffeY AS 5©CIr6' feS <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. qq n <br /> Owner/Operator: *I, letc�,ev �c« nc Y� *1e: <br /> rHerr <br /> Address �?�, B x ltoo ,Z Phone: 91(, 454-336, y <br /> 95L�i,i <br /> Date: <br /> EH 08 05 <br />