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AL HEALTH W`RICT SERVINGS " `I JOAQUIN LOC <br /> BOARD OF TRUSTEES City of Lodi <br /> Jamas Culbertson. Pres. w San Joaquin County <br /> Patricia E. Vannuccl, Sec'y. 1601 East Hazelton Avenue, P. O. Box 2009 City of Escalon <br /> Anthonette van Spronsen City of Manteca <br /> Earl Pimentel Stockton, California 95201 <br /> City of Ripon <br /> Fern Buybee 209/465-6787 City of Stockton <br /> Daniel L. Flores City of Tracy <br /> John D. Mast, M.D. <br /> William J. Wade Jopi Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br /> San Joaquin County <br /> Mary Anna Lore <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 N05 E C <br /> hereby authorize C64/a'd//f <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. (/ // p <br /> Owner/Operator: cl�• � ear Title: Qe?ga e aC ZJv Ways <br /> Address I q()j aS(CCVo &E Phone: 9t 6 - LF0I/ <br /> �Cs iDrs Cd <br /> Date: <br /> EH 08 05 <br />