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` BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> James Culbertson, Pres. SERVING <br /> Patricia E. Vannuccl. Secy City of Lodi <br /> Anlhonetle Van Spronsen 1601 East Hazelton Avenue, P. O. Box 2009 Sen Joaquin County <br /> Eerlel <br /> Bugotr <br /> Fern Stockton, California 95201 City of Escaion <br /> Daniel L.l L.bee City of Manteca <br /> Flores 209/466-6781 CITY of Ripon <br /> John D. Mast. M.D. City of Stockton <br /> William J. Wade Jopi Khanna, M.D., M.P.H., District Health Officer City of Tracy <br /> Mary Anne Love San Joaquin County <br /> 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 " 6L.;1 N -:5Zio-kA01 eOt* J X6 <br /> hereby authorize r i It <br /> to release any and all analytical results, geotechnicaT 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: <br /> Address e Phone: <br /> Date: <br /> EH 08 05 UGT 13 <br />