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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> James Culbertson, Pres. City of Lodi <br /> Patricia tt Vannucci, Secy.Ant1601 East Hazelton Avenue, P. O. Box 2009 San Joaquin County <br /> Earl Pi ette Van Spronsen City of Escalon <br /> Earl Plmentel Stockton, California 95201 City of Manteca <br /> Fern l L. Flo 209/466-6781 City of Ripon <br /> Daniel D. <br /> Flores City of Stockton <br /> Jvim m Mast, M.D. City of Tracy <br /> William J. Wade <br /> Jog] 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 � Z SO. <br /> hereby authorize -1FllI u ldfn LQL' <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: Ivy) 'm"'?)1a Title: <br /> Address hone: <br /> Date: �J -��- <br /> EH 08 05 <br />