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0 0 <br /> BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> James Culbertson, Pres. City of Lodi <br /> Palricle E. Vannuccl, Secy 1601 East Hazelton Avenue, P, O. Box 2009 San Joaquin County <br /> Anthonelte Van Spronsen City of Escelon <br /> Earl Pimentel Stockton, Callfornia 95201 City or Manteca <br /> Fern 13upoee209/466-6781 City of Ripon <br /> Daniel L. Floras City of Stockton <br /> John D. Mast. M.D. City of Tracy <br /> William J. Wade Jogi Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br /> Mary Anna Love 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 1210 E. Victor Road, Lodi , CA 95240 <br /> hereby authorize Canonie Environmental , Stockton, CA 983-1340 <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: I-lic ' C'.4I . — Title: <br /> Address V-0 , 3ct 1 ( I Phone: `41- 1'14V <br /> Date: I -1 -S� <br /> EH 08 05 UGT 13 <br />