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BOARD TRUSTEES SAN JOAQUIN LOCAL HEALTH DISP'dCT <br /> James Culbertson.eon, Pree, SERVING <br /> PatrIcla E. Vannuccl, Secy Clly of Lodi <br /> Anlhonelle Van Sproneon 1601 East Hazelton Avenue, P. O. Box 2009 San Joaquin County <br /> Earl Plmenlel Stockton, California 95201 city of Escalon <br /> Fern Bupbee City of Manteca <br /> Daniel L. Flores 209/466-6781 City of Ripon <br /> John D. Meet, M.D. City of Stockton <br /> William J. Wade Jopl Khanna, M.D., M.P.H., District Health Officer City of Tracy <br /> Mary Anne Love San Joaquin County <br /> 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 1011 N. Broadway, Stockton, CA <br /> hereby authorize Canonie Engineering <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. pp <br /> Owner/Operator:(�a.� 1/ �e � Title: Vcr,-Pes,�/en{ <br /> Address SPiL/4aco T.c� o >r Phone: �� - 5675 <br /> .�O// Al, <br /> J�T6 c KTm.rJ <br /> Date: <br /> 5- <br /> EH 08 05 UGT 13 <br />