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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> James Culbertson, Prea. <br /> Patricia E. Vannuccl, Secy San Joa ulltn of Lodi <br /> Anthonette Van Spronsen 1601 East Hazelton Avenue, P. O. Box 2009 City <br /> County <br /> y of Eaceion <br /> Earl Plmentel Stockton, Callfornla 95201 City of Manteca <br /> Fern Buooee 209/466-6781 City of Ripon <br /> Daniel L. Flores City of Stockton <br /> John D. Meal, M.D. City of Tracy <br /> William J. Wade Jopl Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br /> Mary Anna 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 177 S. Kelly, Lodi , 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 /> OBUO K SHIDA / /� <br /> Owner/Operator: ,� rt (moi _Title: <br /> Address 177 S. Kelly Phone: 334-3030 <br /> Lodi , CA 895240 <br /> Date: <br /> U <br /> EH 08 05 UGT 13 <br />