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. i <br /> BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> James Culbertson, Pres. City of Lodi <br /> Patricia E. Vannuccl, Secy 1601 East Hazelton Avenue, P. O. Box 2DO9 Sen Joaquin County <br /> Anthonette Van Spronsen City of Escalon <br /> Earl Plmenlei Stockton, California 95201 City of Manteca <br /> Fern 6upoee 209/466-6781 City of Ripon <br /> Daniel L. Flores City of Stockton <br /> John D. Mast. M.D. City of Tracy <br /> William J. Wade Jo9l Khanna, M.D., M.P.N., 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 and/or facility <br /> located at 7474 W. 11th Street, Tracy, CA 95376 <br /> hereby authorizeCanonie Environmental , Stockton, CA <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 /> Owner/Operator: �L,— Title: <br /> Address LLI, Phone: a6y <br /> Date: <br /> EH 08 05 UGT 13 <br />