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BOARD OF TRUSTEES SAOAQUIN LOCAL HEALTH DIS.IC T SERVINO <br /> James Culbertson, Pres. City of Lodi <br /> Patricia E. Vannucci, Secy. 1601 East Hazelton Avenue, P. O. Box 2009 San Joaquin County <br /> Anthonette Van Spronsen City of Escelon <br /> Earl Plmenlei Stockton, California 95201 City of Manteca <br /> Fern Bupbee 209/466-6781City of Ripon <br /> Daniel L. Flores City of Stockton <br /> John D. Mast, M.D. City of Tracy <br /> William J. Wade Jopl Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br /> Mary Anm: 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 1111 A)r9TLy , (2F Cil jS1Q <br /> hereby authorize 42er-C ,c, LnQ <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: PLA/Vl ,6I)611URr1Z <br /> Address Phone: 1 44n <br /> Date: <br /> EH 08 05 <br />