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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DIST ICT SERVING <br /> James Culbertson, Pres. City of Lodi <br /> San Joaquin county <br /> Patricia E. Vannuccl, Sec'y. 1601 Bast Hazelton Avenue, P. O. Box 2009 <br /> Anthonette Van Spronsen City of Escaion <br /> Earl Plmentel Stockton, California 95201 City of Manteca <br /> Fern Bugbee 209/466-6781 City Ripon <br /> Daniel L Flores City of Stockton <br /> John D. Mast, M.D. City of Tracy <br /> William J. Wade Jogi 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 <br /> hereby authorize r -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 � <br /> OwnertOperator: r 'f Title: <br /> Address ( �9 Phone: r� <br /> Date: d <br /> EH 08 05 <br />