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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> James Culbertson, Pres. <br /> Lodi <br /> Palrlcla E. Vannuccl, Secy San <br /> of San Joaquin County unty <br /> Anthonette Van Spronsen 1601 East Hazelton Avenue, P. O. Box 2009 <br /> Earl PlmentelStocktonCalifornia 95201 City of Escalon <br /> , <br /> Fern Bupbee City of Manteca <br /> Daniel L. Flores 209/466-6781 City of Ripon <br /> City of Stockton <br /> John D. Mast, M.D. <br /> City of Tracy <br /> William J. Wade Jopl 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 an /or operator of the property and/or facility <br /> located at /�� N #yV—�— yr 0-;,_ <br /> hereby authorize Canonie Environmental <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 � Title: Q LtJ n/-L <br /> Address �"-;,Ac� Phone: <br /> Date: <br /> ru no nr IlnT 11 <br />