Laserfiche WebLink
BOARD OF TRUSTEES <br />James Culbertson, Pres, <br />Palrlcla E. Vannuccl, Secy <br />AnIhonetle Van Spronsen <br />Earl Plmantel <br />Fern Bupbee <br />Daniel L. Flores <br />John D. Mast, M.D. <br />William J. Wade <br />Mary Anna Love <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />SERVING <br />cof <br />1601 East Hazelton Avenue, P. O. Box 2009 San Joaqulin ty Coun yl <br />Stockton, Callfornia 95201 CITY of Escaton <br />City of Manteca <br />209/466-6781 City of Ripon <br />City of Stockton <br />Jopl Khanna, M.D., M.P-H., District Health Officer 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 pp 6�- , �� �j <br />hereby authorize <br />to release any and all anal tical 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/0 <br />Address <br />Date: <br />EH 08 05 <br />Aerator Title: O O <br />Phone: <br />S <br />