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BOARD OF TRUSTEES <br /> JOAQUIN LOCAL HEALTH DIICT SERVING <br /> James Culbertson, Pres. <br /> Patrlcla E. Vannuccl, Sec'y. City Of Lodi <br /> Anthonette Van Spronsen 1601 East Hazelton Avenue, P. O. Box 2009 San Joaquin County <br /> Earl Pimentel Stockton, California 95201 City of Escalon <br /> Fern Bugbee City of Manteca <br /> Daniel L. Flores 209/466-6781 City of Ripon <br /> John D. Mast, M.D. City of Stockton <br /> William J. Wade Jogl Khanna, M.D., M.P.H., District Health Officer City of Tracy <br /> Mary Anna Love San Joaquin County <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 <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 /> Owner/Operator: Title: <br /> Address Phone: <br /> Date: <br /> EH 08 05 Copy <br />