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BOARD OF TRUSTEES SA JOAQUIN''LOCAL HEALTH DISTRICT seRvwa <br /> JamLodi <br /> ei Culbertson, Pres. City of County <br /> Patricia E. Vannuccl, Secy. 1601,East Hazelton Avenue, P. O. Box 2009 sin.City on county <br /> Anthonette Van Spronsen City of Escalon <br /> Earl Pimentel Stockton, California 95201 City of Manteca <br /> Fern Bugbee 209/466-6781Citof on <br /> City of Stockton <br /> Daniel L. Flores City of Tracy <br /> John D. Mast, M.D. <br /> j William J. Wada Jogi Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br /> 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 the property and/or facility, <br /> located at - <br /> hereby authorize <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 /> i <br /> representative. <br /> Owner/Operator: Title: <br /> Address AGi2 Phone: <br /> Date: <br /> EH 08 05 <br />