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s N JOAQUIN LOCAL HEALTH DIS ICT SERVING <br /> BOARt3 OF TRUSTEES City of Lodl <br /> James Culbertson, Pres. San Joaquin County <br /> Patricia E. Vannuccl, Sec'y. 1601 East Hazelton Avenue, P. 0. BOX 2009 City of Escalon <br /> Anthonotte Van Spronsen City of Manteca <br /> Earl Pimentel Stockton, California 95201 <br /> t3ugbea City of Ripon <br /> Fern <br /> 209/466-6781 City of Stockton <br /> Daniel L. Flores City of Tracy <br /> John D. Mast, M.D. <br /> William J. Wade Jogl Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br /> San Joaquin County <br /> Mary Anna Love <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> I , the undersigned owns and/ r operator of the property and/or facility <br /> located at r� -� <br /> hereby authorizeto release any and all analytical r sults, 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: � �'�az'`' <br /> Address ,T �� Phone: <br /> Date: <br /> EH 08 05 <br />