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BOARD ItP,S SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> James Culbertson, Pres. SERVING <br /> Patricia E. Vannuccl. Secy. City of Lodl <br /> Anlhonette Van Spronsen 1601 East Hazelton Avenue, P. O. Box 2009 San Joaquln County <br /> Earl Pimentel Stockton, California 95201 city of Escalon <br /> Fern Rupbee City of Manteca <br /> Daniel L. Flores 209/466-6781 city of Ripon <br /> John D. Mast, M.D. City of Stockton <br /> William J. Wade Jopl Khanna, M.D., M.P.H., District Health Officer City of Tracy <br /> Mary Anna 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 <br /> hereby authorize C,am ig All <br /> to release any and all analytical resu s, 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. 7 <br /> Owned/Operator: Q (__ Title: <br /> Address Phone: <br /> Date: <br /> a r <br /> EH 08 05 UGT 13 <br />