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BOARD OF IRUSIEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> James Culuenfon. Pref. <br /> Patricia E. VannnCCI. Secy. City of Lodi <br /> Anihonelle Van Spronaen 1601 East Hazellon Avenue, P. O. Box 2009 San JoaQuln County <br /> Earl Plmentel Stockton, California 95201 City off Escalon <br /> Manteca <br /> Fern BuDoee <br /> Daniel L. Flores 209/466-6781 City of Ripon <br /> John D. Mast, M.D. City of Stockton <br /> William J. Wada JoDI Khanna, M.D., M.P.H., District Health Officer City of Tracy <br /> San Joaquin County <br /> Mary Anna Lova 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 J STG If TGA y T r00� <br /> hereby authorize ( Je�, <br /> to release any and all ana ytical 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 salve time it is provided to me or my <br /> representative. <br /> Owner/Operator: Title: <br /> Address ' 72 7 �i Doi✓ <F ane: �9�� �� <br /> Oate: <br /> Eli 08 05 UGT 13 r <br />