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BOAR DoP;iRusTEes SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> Jamas Culbertson; Prea. _ <br /> Patricia E. Vannuccl, Secy. City of Lodl <br /> Anthonette Van Spron,en 1601 East Hazelton Avenue, P. O. Box 2009 - San Joaquin County <br /> City of Escelon <br /> Earl Sugbeel Stockton, California 95201 City of Manteca <br /> Fern 209/466-6781 City of Ripon <br /> Daniell L.L. Fl Flores <br /> City of Stockton <br /> Cit <br /> John D. Mast. M.D. City of Tracy <br /> William J. Wade Jopl 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 <br /> hereby authorize <br /> to release any and all analytical results, geotechnical data and site <br /> dssessment 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 /> Owned/Operator: Title: '��b2� <br /> Address 7P 6 '72-- Phone: <br /> Date: _ <br /> cu �� <br /> JAN 2 <br /> ENVIROMENTAL HEALTH <br /> FERMIT/SERVICES <br /> EH 08 05 UGT 13 a <br />