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BOARD OF TRUSTEES SwK4 JOAQUIN LOCAL HEALTH DIN...,fI1CT 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 /> Anthonette Van Spronsen City of Eacalon <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 Jog] Khanna, M.D.,M.P.H., District Health Officer San Joaquin County <br /> Mary Anna Love San Joaquin County <br /> vy <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 f5i2cYYLO(�FF S-7- <br /> hereby authorize Clc�r �c3 L ,IfJS <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: 1 J )V)ke\ it!e: <br /> Address 2-05P 06J Sl—, Phone: 466 -435(0 <br /> S�ct�� c�F: G52�S <br /> Date: i3 Vafq 8C <br /> EH 08 05 <br />