Laserfiche WebLink
BOARD OF TRUSTEES <br />James Culbertson, Pres. <br />Patrlcla E. Vannuccl, Secy <br />Anthonelte Van Spronsen <br />Earl Pimenlel <br />Fern Bupbee <br />Daniel L. Florae <br />John D. Mast, M.D. <br />William J. Wade <br />Mary Anna Love <br />SAN JOAQUIN LOCAL HEALTH DISTR16 <br />SERVING <br />City of Lodi <br />1601 East Hazelton Avenue, P. O. Box 2009 <br />San Joaquin County <br />Stockton, California 95201 <br />tEa <br />CiCityy off Manntecateca <br />209/466-6781 <br />City of Ripon <br />City of Stockton <br />Jopl Khanna, M.D., M.P.H., District Health Officer <br />City of Tracy <br />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 pQ 11Z c <br />hereby authorize <br />to release any and all analytical results, eotechnical 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: Q, q, 2c Title: <br />Address` 7 Phone: I7 <br />Date: <br />EH 08 05 UGT 13 <br />