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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> Jsmea Cultaertson, Pres, SERVING <br /> Patricia E. Vannuccl, Secy City of Lodl <br /> Anlhonetle Van Spronson 1601 East Hazelton Avenue, P. 0. Box 2009 San Joaquln County <br /> Earl Plmonial Stockton, Callfornia 95201 City of Escalon <br /> Fern Bugbeo 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 Jogl Khanna, WILD„ 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 13r, ,I/L 72- C- 1 Gni <br /> hereby authorize (!/.S/D.ti I f Z�Vi , ��/ / n� <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 /> Owner/Operator: &/ Title- ID <br /> V <br /> Address S�ffiC�Ta.,� Phone: <br /> Date: <br /> EH 08 OS UGT 13 <br />