Laserfiche WebLink
S� JOAQUIN LOCAL HEALTH DISORICT SERVING <br /> � BOARD OF TRUSTEES City of Lodi <br /> James Culbertson, Pres. San Joaquin County <br /> Patricia E. Vannuccl, Secy. 1601 East Hazelton Avenue, P. O. Box 2009 City of Escalon <br /> Anthonette Van Spronsen Stockton, California 95201 City of Manteca <br /> Earl Plmentel City of Ripon <br /> Fern Bugbee 209/466-6781 City of Stockton <br /> Daniel L. Flores City of Tracy <br /> John D. Mast, M.D. San Joaquin County <br /> William J. Wade Jogi Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br /> Mary Anna Love <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> I , the undersigned owner and/or operator of thee property and/or facility <br /> located at .3230 uN CO 9D /"+ L)- <br /> hereby authorize �,OLia %[ LAS f - - - <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. � p <br /> Owner/Operator: 1< a Title: <br /> Address , ' o Phone: <br /> ���z 4- IT 9saa3� <br /> Date: — ?3— <br /> EH 08 05 <br />