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BOAAD OF TRUSTEES •N JOAQUIN LOCAL HEALTH DISTRICT <br /> SERVING <br /> James Culbertson, Pres. City of Lodi <br /> Patricia E. Vannuccl, Sec'y. San Joaquin County <br /> Anthonette Van Spronsen 1601 East Hazelton Avenue, P. O. Box 2009 City f Eanteca <br /> Earl Plmentel Stockton, California 95201 city City <br /> of Ripon <br /> Fern Bugbee City t Ripon <br /> 209/466-6781 city of Stockton <br /> Daniel L. Flores <br /> John D. Mast, M.D. CltyofTracy <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 /Ln� fajOa4 n, � <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: / Title: r w /1 <br /> Address_ Phone: <br /> Date: <br /> EH 08 05 <br />