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BOARD of TRUSTEES ,SA*PAQUIN LOCAL HEALTH DIST T SERVING <br /> .-Js Hies eulDonaon, Pros. Clly of Lodi <br /> Palflcls E. Vannuccl, Secy. San Joa ul <br /> Anthonefte Van Sproneen 1601 East Hazelton Avenue, P. O. Box 2009 q n county <br /> Earl Plmenlel City of Escalon <br /> Stockton, California 95201 City of Manteca <br /> Fern Bupbee <br /> Daniel L. Flores 209/466-6781 City of Ripon <br /> John D. Mast, M.D. City of Stockton <br /> City of Tracy <br /> William J. Wade Jog[ Khanna, M.D., M.P.H., District Health Officer San Joaquin County y <br /> Mary Anna Love I�San Joaquin County <br /> VVV v� <br /> AUG 2 2 1986 <br /> E:�NppVIROMENTAL HEALTH <br /> 4pp <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL FfRMAWERVICES <br /> SITE ASSESSMENT INFORMATION p?&( <br /> I , the undersigned owner and/or operator of the property and/or facility <br /> located at 7-4)C', 7—PAY S7-2t Z AC'D r r L41)11 <br /> hereby authorize CAI: t DRnl R We'7-Ek .4q8 <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 /> Owned'/Operator: AL,�AIE Title: <br /> Address __L3 I l LAj Ce&r2J2c-fJ3 Phone: I - 33C/ '3�27�r <br /> - ADD r ('/) <br /> Date: ��� <br /> EH 08 05 UGT 13 <br />