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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> James Culbertson, Pres. <br /> Patricia E. Vannuccl, Secy City of Lodl <br /> Anthonette Van Spronsen 1601 East Hazelton Avenue, P. O. Box 2009 Sen Joaquln County <br /> Earl PlmentelStockton, California 95201 City of Escalon <br /> Fern Bupbee City of Manteca <br /> Daniel L. Floras 209/466-6781 City of Ripon <br /> City of Stockton <br /> John D. Mast, M.D. <br /> City of Tracy <br /> William J. Wade Jopi 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 rand/or facility <br /> located at UN(VS'0S0Y nt ?l e: �bGHGtc NO. swutcc ?6b2 <br /> hereby authorize <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: Ti tl e: Wk^e�k�r„�e� <br /> Address U.OP. Phone: cle�6 25lt{ <br /> t 4524 2 <br /> Date: S <br /> EH 08 05 UGT 13 <br />