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a OARD OF IRUSIEES SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> James Culbertson, Pres. SERVING' <br /> Patricia E. Vannuttl, Secy. City of Lodl <br /> Anthon elle Van Spronsen ..1601 East Hazelton Avenueoaquln County <br /> , P. O. Dox 2009 San J <br /> Earl Plmanfel Stockton, California 95201 City of Escalon <br /> Fun Bugloss City of Maniac, <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 _ 1533 South Stockton Street, Lodi , California <br /> hereby authorize Canonie Environmental <br /> to release any and all analytical results, geotechnical data and site <br /> dssessment 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 /> Owfte4'/Operator: Title: 4«� <br /> Address <br /> ylrgz*"tliam L Maxwell Phone: L2pq-36�-fit 9y <br /> 20109 Greenview Drive <br /> post office 130% #4044 <br /> Date: rl Woodbridge, CA 95296 <br /> , Goll <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT n <br /> 1601 E. Hazelton Ave.-Phone : 466-6781 j b� F19 <br /> P.O. Box 2009 Stockton, Ca. 95201 YYY 'G <br /> Approved <br /> Approved with changes : See Remarks <br /> E] Disapproved ; See Remarks <br /> Remarks <br /> Date di_ _ _—Bye l �✓.e <br /> Approval of these plans extends on to <br /> that which is shown and described here- <br /> on but does not authorize or approve <br /> any omission or deviation of regpirs- <br /> ments of State laws or local Ordinances. <br /> EH 08 05 UGT 13 <br />