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SERVING <br /> BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT City of Lodi <br /> James Culbertson, Pres, San Joaquin County <br /> Patricia E. Vannuccl, Secy. 1601 East Hazelton Avenue, P. O. Box 2009 City of Escaion <br /> Anthonette Van SpronsenCity of Manteca <br /> Earl Pimentel Stockton, California 95201 City of Ripon <br /> Fern Bugbee 209/466-6781 City of Stockton <br /> L. Flores City of Tracy <br /> DanielSan Joaquin County <br /> John D. Mast, M.D. Jogi Khanna, M.D., M.P.H.. District Health Officer San Joaquin County <br /> William J. Wade <br /> Mary Anna Love <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 l� t✓�SS � Sa--�-� -- — J <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 /> Title: <br /> Owner/Operator: — <br /> Address Phone: v?O�/-ma--s-lv/sb2 <br /> 57`dc�ft 9-- 9s'zoG <br /> Date: <br /> EH 08 05 <br />