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TRUSTEES JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> BOARD OFT SAN City of LodI <br /> James Culbertson, Pres. San Joaquin County <br /> Patricia E. Vannuccl, Secy. 1601 East Hazelton Avenue, P. O. Box 2009 City of Escalon <br /> Anthonette Van Spronsen City of Manteca <br /> Earl Plmentel Stockton, California 95201 City of Ripon <br /> Fern Bugbee 209/466-6781 City of Stockton <br /> Daniel L. Flores City of Tracy <br /> John D. Mast, M.D. <br /> William J. Wade Jogl Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br /> San Joaquin County <br /> Mary Anna Love <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> I , the undersigned owner and/or operator of the propertyand/or facility <br /> located at <br /> hereby authorize eCysiaJ 2«� <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: Title: 0,0 <br /> Address Phone: <br /> C/ - <br /> Date: ��Ph <br /> EH 08 05 <br />