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ti <br /> BOARD of TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> James Culbertson, Prea, SERVING <br /> Patricia E. Vannuccl, Secy City of Lodi <br /> Anthonette Van spronsen 1601 East Hazelton Avenue, P. O. Box 2009 San Joaquin County <br /> Ear] Pimenial Stockton, California 95201. City of Escaion <br /> Fern Bugbee <br /> City of Manteca <br /> Daniel L. Flores 209/466-6781. City of Ripon <br /> City of Stockton <br /> John D. Masi, M.D. City of Tracy <br /> William J. Wade Jogl Khanna, M;D,, M.P.H., District Health Officer Sen Joaquin County <br /> Mary Anna Love San Joaquin County <br /> . I <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 851 E. Lodi Avenue, Lodi , CA <br /> hereby authorize Canonie Environmental , Stockton, CA 983-1340 <br /> to release any and all analytical results, geotechnical data and site I€I <br /> J <br /> assessment information to the San Joaquin Local Health District as soon <br /> as itis available and at the same time it is provided to me or my <br /> representative. <br /> Owner/Operator: J Title- <br /> -177 <br /> itle: <br /> Address QST .r _,-�; Phone: C. -7 -, <br /> Date: <br /> . p <br /> � 3 <br />