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BOARD OF TRUSTEES ON JOAQUIN LOCAL HEALTH ATRICT SERVING <br /> Jame; Culbertson, Pres. <br /> Pelrlcla E. Vannuccl, Secy. Clly of Lod[ <br /> Anthonelle Van Spronsen 1601 East Hazelton Avenue, P. O. Box 2009 San Joaquin County <br /> Earl Plmenlel Stockton, California 95201 CITY Clty off Escalon <br /> Manteca <br /> Fern Bugbee <br /> Daniel L. Flores 209/466$781 City of Ripon <br /> John D. Mast, M.D. City of Stockton <br /> City of Tracy <br /> William J. Wade Jog[ 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 G a9 l�/' fSr,e AVS <br /> ark w a,!cam, An{ <br /> hereby authorize L�ailea�e �noi,�r,�r C,P�� .1nc ST��-�T�nrc4 9S�m7 <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 /> Owned/Operator: ? Title: <br /> Address ,yrt4O Sec.+ Sob visit Phone: <br /> (91G) vzs-a>�l <br /> c,ea��ar�T47 <br /> Date: <br /> EH 08 05 UGT 13 ' <br />