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v 4 <br /> .-rte�.�•_., - � � . <br />{ 't3oARfl of rRusTEcs SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> s <br /> James Culbertson, Pres. City of Lodi <br /> Palrlcla E. Vannuccl. Secy. San Joa <br /> Anlhonetle Van Spronsen 1601 East Hazelton Avenue, P. O. Box 2009 quin County <br /> Earl PlmCity of Escalonenrer Stockton, California 95201 L. Flores City of Manteca <br /> Daniel L. Fl <br /> Fern e209/466-6761 City of Ripon <br /> John D. Mast, M.D. City of StocktonCity of Tracy <br /> William J. Wade Jogl Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br /> Mary Anna Love San Joaquin County , <br /> LJ.:.., <br /> AUG _3 a�Ub <br /> li <br /> { CNVIROMENTAL HEALTH <br /> PERI IVSERViCES.--..�' <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL,DATA,A,NO-� --- <br /> SITE ASSESSMENT INFORMATTWO -- - <br /> a <br /> I, the undersigned owner and/or operator of the property and/or facility <br /> t located at 474 W. Grantline Rd. Tracy, Ca. 95376 <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 /> r• representative. <br /> . Owner/Operator: Zaz <br /> T• owner <br /> Address 1137 Roosevelt Ave. Tracy, Ca.�-Z376 <br /> Phone: 835-0836 or 835-1.817 <br /> Date: June 27, 1986 <br /> 1 i <br /> R. <br /> I <br /> EH 08 05 <br />