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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> James Culbertson, Pres. <br /> Patricia E. Vannuccl, Sec'y City of Lodi <br /> Anthonette Van Spronsen 1601 East Hazelton Avenue, P. O. Box 2009 San Joaquln County <br /> Escalon <br /> Earl Pimenfel Stockton, California 95201 City of Manteca <br /> anteca <br /> Fern 8updee CITY of <br /> Oanlel L. Flores 209/466-6781 City of Ripon <br /> tockton <br /> John D. Mast, M.D. City City <br /> of Tracy <br /> City of Tracy <br /> William J. Wade Jopl Khanna, M.D., M.P.H., District Health Officer Sen 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 1847 'Wilson Way, Stockton, CA <br /> hereby authorize Nelson Lab, 3948 Budweiser Court, Stockton, CA 93121266 <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: <br /> Address 9199 Fernwood d Phone: 931-4967 <br /> Stockton, CA <br /> Date: g 9 ✓g <br /> jq <br /> . I <br /> EH 08 05 UGT 13 <br /> ,. _ - _ All <br />