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euARD'OF TRUSTEES SAN J0 <br /> LOCAL HEALTH DISTRICT SERVING <br /> James CulDenson. Pres.PatricCity of Lodl <br /> Anihola vann uccl, sec y. 1601 East Hazelton Avenue, P. O. Box 2009 San Joaquin Count <br /> AnlhoneItlte Van Spronsen Clty of Escalon <br /> Earl Plmentel Stockton, California 95201 city of Manteca <br /> Fern L. <br /> Flores $09/466-6781 City of Ripon <br /> oee <br /> Daniell LL. Flo <br /> John D. Mast, M.D. City of Stockton <br /> 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 <br /> hereby authorize <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 /> Own4/Operator: Title: <br /> Address — /,N _ ��11r/ , Phone: <br /> Date: <br /> EH 08 05 UGT 13 <br />