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BOARD of TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> City of Lodl <br /> James Cul0en s6n. Pres. .' <br /> Patricia E. vanniuccl, Secy Sen JosquM County <br /> Anihonetie van'Spronaen 1601 East Hazelton Avenue, P. O. Box 2009 City of Eacalon <br /> Earl Pimentai Stockton, California 95201 CHV of Manteca <br /> • City of Ripon <br /> Fern 6upbee 20$/466-6781 <br /> Daniel L. Flores, Cll} Stockton <br /> John D. Mut, M.D. City of Tracy <br /> sltn 011icer <br /> William J.Wade JoDI Khanna, M.D., M.P.H., District Hea San Joaquin County <br /> San Joaquin County <br /> 'dary Ann■ Loy* <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, QA Phone: 46fi-0851 <br /> Dater <br /> 2 <br /> t <br /> v, <br /> 4 <br /> a <br /> FH 08 OS GT ' <br />