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• <br /> BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> James Culbertson. Pres, <br /> Patricia E. Vannuccl. Secy City of Lodi <br /> Anlhonette Van Spronson 1601 East Hazelton Avenue, P. O. Box 2009 San Joaquin County <br /> Earl Plmenlel Stockton, Callfornla 95201 City of Escelon <br /> Fern BupDeo <br /> City of Manteca Daniel L. Flores 209/466-6781 City of Ripon <br /> John D. Mast, M.O. City of Stockton <br /> � City of Tracy <br /> William J. Wade Jopl Khanna, M.O., M.P.H., District Health Officer n Joaquin County <br /> Mary Anna Love quln County <br /> F�MTE�TAC o <br /> ti <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 1313 S. Stockton Street, Lodi , 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. <br /> Owner/Operator: '�� / j Title: <br /> Address Tny 7 - Phone: <br /> �2 Z//C <br /> Date: <br /> EH 08 05 UGT 13 <br />