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it <br /> tlO OF TRUSTEES <br /> James Culbertson. Pres, SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> sa <br /> Patricia E. Vannuccl, Secy SERVIND <br /> Anthonelle Van Spronsen 1601 East Hazelton Avenue, P. O. Box 2009 San Joaq Ily 01 ln County di <br /> Earl Plmenlel Stockton, Calltornia 95201 <br /> Fern BupDao City of Eacelon <br /> Daniel L. Flores 209/466-6781 City of Manteca <br /> Ift' John D. Meat, M.D. City of Ripon <br /> William J, Wade Clly of Stockton <br /> Mary Anna Love Jopl Khanna, M.D., M.P.M., District Health Officer City of Tracy <br /> Sen Joaquin County <br /> Sen Joaquin County <br /> r <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> L <br /> L. I , the undersigneowner and/or oper or f the rope ty and/or facility <br /> � <br /> located at ��77// <br /> �� ��� <br /> L hereby authorize ,qL ^ [tJ q c� L <br /> d akthS <br /> to release any anll 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 /> Owner/Operator <br /> /� L)O Title: P/1Address -[, — Phone: <br /> ell <br /> Date: <br /> r <br /> r^ <br /> F <br /> a–EH 08 05 <br />