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io ►Ao or tnustEEs SAN J AQUIN LOCAL HEALTH DISTRICTf� <br /> fames Culbenson. Pier. SEAVINO <br /> 'eiNcle E. Vannuccl, Secy. Cltyof Lodi <br /> knlhonette van splonsen 1601 East Nazellon Avenue. P. O. Box 2009 San Joe <br /> Quln County <br /> E.rI PlmaMal Stockton. Calllornia 95201 <br /> Clly of Eacalon <br /> =e(n supbea. _ City of Maniac& <br /> )anlaf L. Floss 209/466-6781 City of Ripon <br /> John O. Most. M.O. City of Stockton <br /> Ylfllam J.Wade Jopl Khanna. M.O.s M.P.H.. District 1464111h Officer City of Tracy <br /> Bary Anna Love San Joaquin County . <br /> San Joaquin County <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 G <br /> hereby authorize <br /> to release any and all analytical results, geotechnical data and 'site <br /> dssessment 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 /> Owned/Operator: Title: � ,� <br /> Address 1 /I, 4/f 17 Phone. . <br /> Date: `-7 4<1 <br /> 11 08 05 UGT 13 <br />