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r <br />UOAPO OF TRUSTEES <br />James Culberfeon, Pre, <br />Patricia E, Vannuccl, Sec'v <br />Anlhonatte Van Spronsen <br />Earl Pimento; <br />Fern Bupoeo <br />Daniel L. Flores <br />John D, Malt, M.0 <br />William J. Wade <br />Mary Anna Love <br />0 0 <br />SAN JOAQUIN LOCAL HEALTH 01STHIC;T <br />1601 East Hazelton Avenue, P O Box 2009 <br />Stockton, Calltornia 95201 <br />209/466-6781 <br />JOQi khanoa, M.D., M.P.H•, District Health Officer <br />AU"H' RI?P [:;Ft FJ R:.L:AS.E At'`�ALYr;CAI- RIS01- GEO':I:!"NNI At. DA-,.." 9110 <br />SITE ASSESSMENT IN~GRMATION <br />SFRVINO <br />City of Lodl <br />San Joaquln County <br />City of E,colon <br />Illy of Monloca <br />City of Ripon <br />City of Stockton <br />CII/ of Tracy <br />San Joaquin County <br />San Joaquin County <br />I, the undersigned owner and/or operator of the property and/or facility <br />located at LdFayette & Wilson Way and Sanguinetti & Mistletoe, Stockton, CA <br />hereby authorize Canonie Environmental, Stockton, CA <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 />r <br />Owner/Operator: <br />Address. <br />r <br />Date: <br />EH 08 05 ',+1 <br />itie l - <br />hone.:' <br />