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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> James Cul✓enson, Pres, <br /> Patricia E. Vannuccl. Secy City of Loth <br /> Anlhonette Van Spronsen 1601 Fast Ha2elton Avenue, P. Q. Box 2(X)9 San Joaquin County <br /> Earl PimentelCity of Escalon <br /> 0 <br /> Fain Bu oee Stockton, California 95201 City of Manteca <br /> Daniel L. Flores 209/466-6781 city of Ripon <br /> John D. Mast, M.D. City of Stockton <br /> Clly of Tracy <br /> William J. Wade Jopl Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br /> Mary Anne Love o <br /> 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 03� <br /> hereby authorize <br /> to release any and all analytical re Its, ge ethnical 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 /> Owner/Operator: <br /> Ina i heJ5 Title: <br /> Address S S� S ,v e to( Phone: <br /> Date: <br /> EH 08 05 UGT 13 a <br />