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BOARD OF TRUSTEES • <br /> James Culbertson, Pres. <br /> Patricia E. Vannuccl, Secy. SAN JOq(?U1N <br /> Anthonette Van Spr I ac LOCAL HEALTH DISTRICT <br /> Earl Pimentel 1601 East Hazelton Ay <br /> Fern Bu Avenue SERVING <br /> Daniel LBFelores Stockton, P' 0' Box 2009 city or Lodi <br /> California 95201 San Joaquin County <br /> John D. Mast, M.D. 209/466- City of Escalon <br /> William J. Wade 6781 <br /> Mary Anna Love CitiManteca <br /> Jo81 Khanna, M.D., M.P,H„ District Health Officer City <br /> of Ripon <br /> City of Stockton <br /> y of Tracy <br /> San Joaquin County <br /> San Joaquln County <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> I, the undersigned owner and <br /> located at /or operator of the property and/or facility <br /> _ Ali <br /> hereby authorize �o u_ <br /> to release any and all analytical results <br /> data <br /> assessment information to the San Joaquin ,Local HealthlDiistrictdaslte soon <br /> as it is available and at the same time it is provided to me or my <br /> representative. <br /> Owner/Operator: 1/ <br /> Title: 6 el <br /> Address Z /y;(� Q �n_ Phone: y <br /> Date: <br /> v <br /> J <br /> UN 2 1986 <br /> EtiFIRM j/yERVICES, <br />