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SOARO OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING` <br /> James Culperleon, Pros, <br /> Patricia E. Vennuccl, SecyCity of Lodi. Sen Joaquin Anihonsile Ven Spronsen ..1601 East Hazelton Avenue, P. O. Box 2009 County <br /> City of Escalon <br /> Earl Pimentel Stockton, California 95201 city of Maniacs, <br /> Fern BuOoee City Daniel L. Flores 209/466-6781 y o1 Ripon <br /> John D. Masl, M.D. City of Stockton <br /> City of Tracy <br /> William J. Wade Jo01 Khanna, M.D., M.P.H., District Health Officer Sen Joaquin County <br /> Mary Anne 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 (g�� , 'e - c°Cr4 eV�icS�R/ry/u �R/c <br /> hereby authorize (/a,/i-t mu&" Y— La j(mo) <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 /> Owner/Operator: A/ (14/ 14111 Title• zk es ' <br /> Address a t Phone: ��3 <br /> ^ItAL��lh <br /> Date: 67t 3�7 o <br /> Ell 08 05 UGT 13 <br />