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BOARD 9F ,RuslEes SAN J%kQUIN &AL.HEALTH DISTRLrC SERVING <br /> Jmea Cutben son, Pros. City of Lodl <br /> Palacio E. Vannuccl, Secy. 1601 East HazeltonAvenue,.P. O. Boz 2009 San Joaquln County <br /> r Anlhonetle Van Spronsen City of Escolon <br /> Earl Plmanlel Stockton, Callfornia 95201 City of Manteca <br /> Fern BuObee 209/46611781 City of Ripon i <br /> Daniel L. Flores City of Stockton <br /> John D. Mast, M.D. City of Tracy l <br /> William J. Wade Jopl Khanna, M.D., M.P.H., Dlatrtst Health Officer San Joaquin County y <br /> Mary Anna Lova 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 24124 N. BRUELLA RD. ACAMPO, CA <br /> hereby authorize CALIFORNIA WATER LABS. <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 /> Ownef/Operator: P1. a�L—,r Title: <br /> Address 24124 N BRUELLA RD. Phone: <br /> ACAMPO, CA a <br /> Date: <br /> 0 n <br /> 010jj DEC p 1 i9do <br /> ENVIROMENTAL HEALTH <br /> FERMIT/SERVICES <br /> a <br /> EH 08 05 UGT 13 <br />