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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> James Culbertson. Pros SERVING. <br /> Patricia E. Vannuccl, Secy City of Lodl <br /> Anthonetle Van Spronaon 1601 East Hazelton Avenue, P. O. Box 2009 San Joaquin County <br /> Earl Plmenlel Stockton, California 95201 City of Escalon <br /> Fern Bugbee City of Manteca <br /> Daniel L. Flores 209/466-6781 City of Ripon <br /> John D. Mast, M.D. City of Stockton <br /> William J. WadeCity of Tracy <br /> Jogl Khanna, M.D., M.P.M., District Health Officer San 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 612 Buena Vista Avenue , Stockton , CA <br /> hereby authorize Canonie Environmental <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 /> Owner/Operator: Title: <br /> Address 612 uena Vista Ave Stockton -LA—Phone: 466-0851 <br /> Date: <br /> EH 08 05 UGT 13 <br />