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BOARD of TRUSTEES SAN JOAOUIN LOCAL HEALTH DISTRICT <br /> SERVING <br /> James Culbertson, Pres. <br /> E. Vannuccf, Secy City of Lodi <br /> PatriciaPat icia Ee Van Spronsec 1601 East Hazelton Avenue, P. O.. Box 21309 San Joaquln County <br /> City of Eacalon <br /> Earl Pimentel Stockton, Callfornra 95201 <br /> C11y of Manteca <br /> Fern Bupdee <br /> Daniel L. Flores City City of Ripon <br /> City of Stockton <br /> John D. Mast, M.D. City of Tracy <br /> William J. Wade Jopl 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 260 S. Main Street, Manteca, CA <br /> hereby authorize Canonie Environmental , Stockton, CA <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 /> r r�Owner/Operator: d t,�l� / Title: e/Q <br /> Address Phone: <br /> Date: <br /> EH 08 OS UGT 13 <br />