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v .fir <br /> BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> James Cult»rtson, Pres. City of Lodi <br /> Patricia E. Vannuccl,Seoly. 1601 East Hazelton Avenue, P. O. Box 2009 San Joaquin County <br /> Anthonatte Van Spronseq Clty of Esulon <br /> Earl Plmentel Stockton, California 95201 city Cityof <br /> Manteca <br /> of Fern Buobee City yCity <br /> Stockton <br /> Ripon <br /> Daniel L. Flores t <br /> John D. Mast, M.D. y 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 and/or facility L <br /> located at ao& SIB.££ A..£\\f K yl^If-q��S <br /> hereby authorize 0,A.-tF WlP'r'Ey— LPV6 — Y�OpfSy o LFA <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 /> LOwner/Operator: V Title: <br /> Addhess �? 6 4 1 vWA.5 Phone: 33o I <br /> 3n0Kxo+J Oeo q s.2 oS <br /> Date: 1 O — 1 � - <br /> .r l: <br /> i i y <br /> OCT g 9 1988 <br /> PERa91i I SL`;ViC:Es' <br /> EH 08 05 <br />