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BOARD OF TRUSTEES SA*OAQUIN LOCAL HEALTH DISOCT <br /> James Culbertson, Pres. SERVING <br /> Patricia E. Vannuccl, Secy Clly of Lodi <br /> Anthonetle van Spronson 1601 East Hazelton Avenue, P. O. Dox 2009 San Joaquin County <br /> Earl Ptmeniel Stockton, California 95201 Clly of Escaton <br /> Fern Bupbea City of Manteca <br /> Daniel L. Flores 209/466-6781 City of Ripon <br /> John D. Mast, M.D. City of Stockton <br /> William J. Wade Jog[ Khanna, City of Tracy <br /> 0 M.D., M.P.H., District Health 011lcor San Joaquin y <br /> Mary Anne love q Count <br /> San Joaquin County <br /> MAY 18 1987 <br /> ENVIROMENTAL HEALTH <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS , GEOTECHNICAL DATA AN�ERMIT/SERVICES <br /> SITE ASSESSMENT INFORMATION <br /> I , the undersigned owner and/or operator of the property and/or facility <br /> located at -f49f'4f 00-aE- 149:Zy' A-11-4=2-L-�1-5- <br /> hereby authorize �r¢A/B�c%t ✓lRewaAr y7' L <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:�ytl <br /> Address p1�, �� f<�y �7 Phone: ,"� 3 -��t7 <br /> Date: <br /> EH 08 05 UGT 13 <br /> MENNEN, -94 <br /> r 7/Sl' <br />