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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> James Culbertson, Pres. SERVING <br /> Patricia E. Vannuccl. Secy City of Lodi <br /> Anthonelle Van Spronson 1601 East Hazelton Avenue, P. O. Box 2009 San Joaquin County <br /> Earl Plmenlel City of Escaion <br /> Stockton, California 95201 <br /> Fern Bupbee City of Manteca <br /> Daniel L. Flores 209/466-6781 City of Ripon <br /> John 0. Mast, M.D. City of Stockton <br /> William J. Wade Jogi Khanna, M.D., M.P.H., District Health Officer City of Tracy <br /> Mary Anne 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 8910 E. Hwy 12 , Victor, CA <br /> hereby authorize Canonie Engineering _ <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. zr�`� <br /> Owner/Operator: � ` Title: C� <br /> Address 8910 E, wy 12 Phone: 369-2973 <br /> Victo , CA <br /> Date: /ol— !9 ` �� <br /> EH 08 05 UGT 13 <br />