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BOAR <br /> James <br /> ul TRUSTEES <br /> pre; SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> James Cuftsertaon, Preis. SERVING <br /> Patricia E. Vannuccl, secly. City of Lodi <br /> Anthonette Van Spronise41601 East Hazelton Avenue, P. 4. Box 2009 San Joaquin County <br /> Earl Plmentel Stockton, California€#5201 City of Escalon <br /> Fern Bugbee City of Manteca <br /> Daniel L. Flores 201/466-6781 City of Ripon <br /> John D. Mast, M.D. City of Stockton <br /> William J. Wade Jog] Khanna, M.D., M.P.H., District Health Officer City of Tracy <br /> Mary Anna Love San Joaquin County <br /> 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 /> 1 o c a t ed at "? © O C? Thr LJ j cry <br /> ._._�)2(2�A-n1 rte'—O'g ..CA . <br /> hereby authorize <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 ZXTitle: <br /> Phone: <br /> Address �' <br /> .� �«, r.� ' y <br /> Date: <br /> x - <br /> d <br /> EH 08 05 <br />