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I <br /> BOARD of TRU5TEE5l$ JOAQUIN LOCAL HEALTH D1k14' <br /> LCT sERVINa <br /> Jpdvea Culbertson, Pres. City of Lodi <br /> Patricia E. Vannuccl, sec'y. San Joaquin County <br /> 1601 East Hazelton AP. 0. B 2009 <br /> 'Anthonette Van Spronsen <br /> Avenue, ox <br /> Cllyof Escalon <br /> Earl Pimentel Stockton, California 95201 City of Manteca <br /> Fern Supbee <br /> Daniel t.rinres 209/466-6781 City or Ripon <br /> City of Stockton <br /> John D. Mast, M.D. <br /> City of Tracy <br /> William J. Wade Jog] Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br /> Mary Anna Lova San Joaquin County <br /> w <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> .f <br /> SITE ASSESSMENT INFORMATION <br /> I, the undersigned owner and/or operator of the propertyff and/or facili <br /> C� <br /> located at d3 NO•(-�'rvl WCC -- ©CSC 00f C Q i .. <br /> hereb authorize , . �I• S ' <br /> �.� y _ <br /> r. to release any and all . analytical results, geotechnical data and site <br /> .r <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 0 e ," b Y ` <br /> I p rator• A �erc �e✓ � c Title: E���w� � Gzs�Kp« <br /> Address ?D r3� �SFr� _ Phone: y3c � <br /> i Date: ria-Ar 4, <br /> r <br /> EH 08 05 <br />