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BOARD OF TRUSTEES SAq JOAQUIN LOCAL HEALTH DIS'-."IICT SERVING <br /> James Culbertson, Pres. City of Lodi <br /> Patricia E. Vannuccl, Secy. 1601 East Hazelton Avenue, P. O. Box 2009 San Joaquin County <br /> Anthonetle Van Spronsen City of Escalon <br /> Earl Plmentel Stockton, California 95201 City of Manteca <br /> Fern Bugbee 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 Jogl Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br /> Mary Anne 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 T: DAI2 r {- <br /> hereby authorizeYYJCr IS/O!1 Sl7[Ttf �'l/QS <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: �.fl d.� Title: / W72PY" <br /> Address 2S'7 P .1, n _Phone: <br /> '61�pr <br /> Date: 4'6 7a <br /> FEB 2 7 1987 <br /> ENW(L)MENTAL HEALTH <br /> FERMIT/SERVICES <br /> EH 08 05 <br />