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80ARD-OF TRUSTEES JOAQUIN LOCAL HEALTH DI$RICT SERVING <br /> 'James Cult}ertsOn, Pres. City of Lodl <br /> Patricia E. Vannuccl, Secy. 1601 East Hazelton Avenue, P. 0. BOX 2009 San Joaquin County <br /> Anthonette Van Spronsen City of Escalon <br /> Earl Pimeniel Stockton, California 95201 City of Manteca <br /> Fern Bugt)ee 209/466-6781 City of Ripon <br /> C1ty of Stockton <br /> Daniel L. Flores <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 operators of the property and/or facility <br /> located at i.�pQ PAC-1 r% C A01 <br /> hereby authorize _ 1 W6 �NC ,- <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/OperatorTitle: <br /> Address J� _ Rhone:�Z 73_ J'�2 a a <br /> J—) <br /> Date: <br /> EH 08 05 <br /> _ i <br />