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GOARU Of TRUSTEES SAN JOAOUIN LOCAL HEALTH DISTRICT SERVIN0 <br /> James Culbertson. P'es. <br /> Paiticia E. vannvccl, Secy. City of Lodi <br /> AnlhonalH Van SPlonaen <br /> 1601 East Hazelton Avenue, P. O. Boa 2019 San Joao;,ln county <br /> Ead City of Escalon <br /> Fatn Su0 beai Stockton. California 95201 Cly of Manteca <br /> Daniel L. Flotea Y09/466-67$1 City of Ripon <br /> John O. Mast, M.O. City of Stockton <br /> City of Tracy <br /> MaryWilliamA J. Wade Jopl Khanna, M.O., M.P.H., District Health Ofllcer Sen Joaquin County <br /> Mary Anna Love San Joaquin County <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> 1, the undersigned owner and/or operator of the property and/or facility <br /> located 'at D <br /> hereby authori e <br /> to release any and all analytical results, geotech 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 /> Ownef/Operator: Title: <br /> Address Phone: �� 9 <br /> c <br /> Date: <br /> 111 08 05 UGT 13 <br />