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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> James Cul Denson. Pres. City of Lodi <br /> p&l(Icla E. Vannuccl. Secy 1601 East Hazelton Avenue, P. O. Box 2009 San Joaquin County <br /> Anlhonetle Van Soronsen City of Escalon <br /> Earl Plmenlel Stockton, Callfornla 95201 City of Manteca <br /> Fern BuDbee 209/466-6761 City of Ripon <br /> Daniel L. Flores City of Stockton <br /> John D. Mast, 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 RSanjoaquln County <br /> , rm�i <br /> 06 Ad <br /> Fiyh,Ro J 6 . O <br /> FSM lENlq( <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND h <br /> SITE ASSESSMENT INFORMATION <br /> I , the undersigned owner and/or operator of the property and/or facility <br /> located at 204 and 228 E. Lodi Avenue, Lodi , CA <br /> hereby authorize fannnie Engineering <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 salve time it is provided to me or my <br /> representative. <br /> Owner/Operator: Ti tl e: �� <br /> al--.1 <br /> Address 1250 Edg _ood Drive Phone: 369-3215 <br /> Lodi , CA 95240 <br /> Date: <br /> EN 08 05 UGT 13 <br />