Laserfiche WebLink
BOAID OF TRUSTEES �.nJ JOAQUIN LOCAL HEALTH d � RICT sE�viNc <br /> James Culbertson,Pres. <br /> Mary Anna Love,vice Pre*. 1601 East Hazelton Avenue, P.O. Box 2009 city of Lod <br /> Patricia E.Vannuccl,Secy. San Joaquln County <br /> Tommy Joyce Stockton, California 95201 San Joaquin County <br /> Earl Pimenlef Clly of Escalon <br /> Virginia Mathews (209) 466-6781 City of Manteca <br /> Daniel L Flores City of Ripon <br /> John D.Mast, M.D. City of Stockton <br /> Jogi Khanna,M.D.,M.P.H.,District Health Officer :r.. City of Tracy <br /> Gene S.Kraham <br /> San Joaquin County <br /> AUTHORIZATION TO RELEASE ANALYTICAL [INSULTS , GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> „ I , the undersigned owner ane!/or operator of the property anti/or facility <br /> located at <br /> c v . i.c�r � r v E _S_' <br /> r-v c <br /> hereby authorize 1 <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 . <br /> Owner/Operator : <br /> Title: <br /> Address 31 0 ' , W -,r3 t'" phone: /z 3 <br /> Dat(,-: <br /> EH 23 091 3/86 <br /> !sl[ <br />