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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> SERVINO <br /> James Culbertson, Pres. <br /> Patricia E. Vannuccl, Secy City of Lodl <br /> Anthonette Van Spronsen 1601 East Hazelton Avenue, P. O. Box 2009 San Joaquin County <br /> Earl Plmentel Stockton, Callfornia 95201 city of Escalon <br /> Fern Bupbee City of Manteca <br /> Daniel L. Flores 209/466-6781 City of Ripon <br /> John D. Mast, M.D. City of Stockton <br /> MJ. Wade Jopl Khanna, M.D., M.P.H., District Health Officer <br /> Mary <br /> A San Joaquin County City of Tracy <br /> 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 2180 E. Mariposa Road, Stockton, CA <br /> hereby authorize Canonie Environmental . 212 Frank West Circle Suite A 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 /> Owner/Operator: Title: <br /> Address _//1/ g� .,� /;,�,rs q/ Phone: <br /> Date: /2 - / °f' 97 <br /> EH 08 05 UGT 13 <br />