Laserfiche WebLink
BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> SERVING <br /> James Culbertson. Pros. <br /> Patricia City of Lodi <br /> Anlhonette Ven Spronaen Vannucci, Secy 1601 East Hazelton Avenue, P. O. Box 2009 San Joaquin County <br /> lt <br /> Earl PlmenlelStocktonCalifornia 95201 City of Escalon <br /> , <br /> Fern Bugbee City of Manteca <br /> Daniel L. Flores 209/466-6781 City of Ripon <br /> City of Stockton <br /> John D. Mast, M.D. <br /> City of Tracy <br /> William J. Wade Jogl Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br /> Mary Anna Love Sen 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 pp am <br /> hereby authorized/nl6 35239 <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—lime it is provided to me or my <br /> representative. {{�� <br /> Owner/Operator: Z Lida eo Title: <br /> Address o < CV C' Phone: 0`790 <br /> �o�; NA �15'1yD <br /> Date: <br /> i <br /> EH 08 05 UGT 13 <br />