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BOARD OF TRUSTEES ON JOAQUIN LOCAL HEALTH DORICT SERVING <br /> James Culbertson, Pres. City of Lodi <br /> Patrlcle E. vannuccl, sec y. 1601 East Hazelton Avenue P. O. Box 2009 San Joaquin County <br /> Anthonetttte Van Spronsen ' City of Escalon <br /> Earl Plmentel Stockton, California 95201 City of Manteca <br /> Fern Bugbee <br /> Daniel L. Flores 209/466-6781 City Ripon <br /> John D. Mast, M.D. City CityStockton of Tracy <br /> William J. Wade Jogl 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 '?q 7q' Al- 1416,r/uJ/+ yn 59 9,0,C/+DA <br /> hereby authorize WL-1'n1F'G- /'DE,x /7S$?CIAfG-S <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/Opera or:�1 ���•---<<` Title: 4rtr: li 6 <br /> Address 210 l _?hone: 2'017 ., --t"54 3 <br /> MC�rn,y C,� �SZc?'7 <br /> Date: 2- — d' <br /> EH 08 05 <br />