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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT URVING <br /> James Culbertson, Pres. City of Lodi <br /> Patricia E. Vannuccl, Secy 1601 East Hazelton Avenue, P. O. Box 2009 San Joaquin County <br /> Anthonette Van SPronsen City of Escalon <br /> Earl Plmentel Stockton, California 95201 City of Manteca <br /> Fern Bupbee 209/466-6781 City Ripon <br /> Daniel L. Flores Clly of Stt ockton <br /> John D. Mast, M.D. City of Tracy <br /> William J. Wade Jogi Khanna, M.D.. M.P.H., 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 /� CC/. J z civ �if _ �L <br /> hereby authorize ( V C <br /> to release any and all analytical resul s, geotech 'cal 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: (VA)P eke C2d171 < HCC 1A7C Title: Fart _fbNr <br /> GAIZDO-AA <br /> Address P 0 r5oX 369 --Phone: 707_37c1-a8 f C_�TA�' <br /> SIO SISTA «- Cl �I <br /> Date: <br /> EH 08 05 <br />