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r BOARD OF TRUSTEES • <br /> .lamas CulFert3on. Pres. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT Patrlcle E. Vannuccl, SecySERVING <br /> Anthonetle Van Sproneen 1601 East Hazelton Avenue, P. O. Box 2009 San Joaqu itn county <br /> Bugoe <br /> of Lodl <br /> Fern B <br /> Earl el Stockton, California 95201 City of Escalon <br /> Daniel L. Fee City of Manteca <br /> Flores 209/466-8781 City of Ripon <br /> John D., Mast, M.D. _ City of Stockton <br /> William J. Wade Jog[ 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 pro and/or facility <br /> located at 3 F . f W A <br /> o T <br /> hereby authorize t <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 /> Owned/Ops tor: <br /> Title: it V <br /> Address --- Phone: (� <br /> Date: <br /> DEC 2 9 Iyr , <br /> ENVIRUMENTAL HEALTH <br /> PERMIT/SERVICES <br /> e r � <br /> EH 08 05 UGT 13 i 13 <br />