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t10AR0' OF TRUSTEES SAN PAOUIN LOCAL HEALTH DISTRIP <br /> James <br /> Culbertson, Pre a. <br /> SERVINO <br /> Patricia E. Vannuccl, Secy City of Lodi <br /> Anthonette Van Spronsen 1601 East Hazelton Avenue, P. O. Box 2009 San Joaquln County <br /> Earl Plmentel Stockton, California 95201 City ity of of Manteca <br /> lon <br /> Fern 9upbee <br /> Daniel L. Flores 209/466-6781 City of Ripon <br /> John D. Mast, M.D. City of Stockton <br /> WilliCity of Tracy <br /> Mary m J. Wade Jopi Khanna, M.D., M.P.H., District Health Officer Sen 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 1119 Roosevelt, 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 /> M LLE & AIL TILE CO. <br /> Owner/Operator: 11, 9' ,:�i , Title: C-,,/I <br /> Address 1119 Roosevelt Phone: 466-3083 <br /> Stockton, CA <br /> Date: 5 Z S SS K <br /> EH 08 01 UGT 13 <br />