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D TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> James Culbertson. Pres. SERVING <br /> Patricla E. Vannuccl, Secy. City of Lodl <br /> Anthonstle Van Spronsen 1601 East Hazelton Avenue, P. O. Box 2009 San Joaquln County <br /> Earl Plmentel Stockton, Callfornia 95201 City of Escalon <br /> Fern Bupoee Clty of Manteca <br /> Daniel L. Flores 209/466-6781 City of Ripon <br /> John D. Mast, M.D. City of Stockton <br /> William J. Wade Jogl Khanna, M.D., M.P.H., District Health Officer City of Tracy <br /> Mary Anne Love San Joaquin County <br /> In <br /> County <br /> OEC 2 2 198b <br /> ENVIROMENTAL HEALTH <br /> PERMIT/SERVICES <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 �14y &—, ,GA ?'IrLae <br /> hereby authorize C�}L/feQieli� ��/ Z4AeA941ora <br /> to release any and all analytical results, geotechnical data and site <br /> dssessment 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 /> Owned/Operator: r Title: <br /> z <br /> Address Phone: S O <br /> c�1 oC�e�� �eS7�S <br /> Date: <br /> a r <br /> EH 08 05 UGT 13 i3 <br />