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BOARD OF TRUSTEES JOAQUIN LOCAL HEALTH DIICT SERVING <br /> Jamas Culbenson, Pres. City of Lodi <br /> Patricia E. vannuccl, Sec'y. 1601 East Hazelton Avenue P. 0. Box 29 San Joaquin County <br /> Anihonette Van Spronsen 00City of Escalon <br /> Earl Pimeniel Stockton, California 95201 City of Manteca <br /> Fern Buybea 209/466-6781 City of Ripon <br /> Daniel L. Flores Clty of Stockton <br /> John D. Mast. M.D. City of Tracy <br /> William J. Wade Jogl 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 and/or operator of the property and/or facility <br /> located at S PA <br /> hereby authorize 0 N t f in1EL" INGL_ T&C•-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: <br /> Address J'�.a a - Phone: T-2 o il <br /> Date: <br /> EH 08 05 <br />