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! 30ARD OF TRUSTEES <br /> James Culbertson!Pres. AN JOAOUIN LOCAL HEALTH STRICT <br /> Mary Anna Love,Vtce Pres. SERVI <br /> Patricia E.Vannuccl,Secy, 4 601 East Hazelton Avenue, P.O. Box 2009 City of <br /> Tommy Joyce San Joaquin Cot <br /> Earl Pimentei Slockton, California 95204 ° San Joaquin Co( <br /> Virginia Mathews City of Esc4 <br /> Daniel L Flores (209) 466-6784 City of Mani <br /> John D.Mast,M.D. j f City of Ri <br /> Gene S.Kraham Jog!Khanna,M.D.,M.RH.,District Health Officer City of Stock <br /> City of Tr. <br /> San Joaquin Cou <br /> V <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA <br /> SITE ASSESSMENT INFORMATION TA AND <br /> I , the undersigned owner and/or operator of the property p perty and/or facility <br /> located at 6, <br /> hereby authorize t �'�' <br /> to release any and all analytical results, , <br /> geotechnical data and site <br /> assessment information to the San Joaquin Local Health District <br /> as it is available and at the same time it is provided to me o as Soon <br /> representative, r my <br /> Owner/Operator: <br /> Address r �� (,1D�N`ILl -�•c� Tit1e: <br /> 0! 13oK 3550 Jlv to a Phone: -114' <br /> Date: � ' 2` • <br /> EH 23 041 3/86 <br /> t <br /> Elf . <br /> ..-^'� '�" • .*�,'S'�,�"-'M,a+a"7�"'+�"' �� 'r-a.^rx-a'+a�_ s-°�ir����^'9srM�x+.�-,r�z�'+S�eR-c - '�""'�"'}"�'p?sg''�ryr�.'°�'�"". <br />"w. «.:a so�tly. .,s.l.. .-,y. ...$..N±a -,....: M,..:.r:- . ...,:+t _ .0 ..i;-,..l, L3;� .. ._ - 1. •-.a '�xi: o� .:'�+ i�y \\ f*r'- +2-.-. - <br />