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bOARO OF 1RUStEES SAN JOAOUIN LOCAL HEALTH DISTRICT <br /> James Cullerlson. P#ef. SERVINO <br /> Palrlcle E. Vannuccl, Secy. Cltyof Lodi <br /> Anthonelle Van Spronsen 1601 East Hazelton Avenue, P. O. Boz 2009 San Joaquin County <br /> Earl Plmentel Stockton. Callfornia 95201 City of Escalon <br /> Fern Bupoee Clay Of Manteca <br /> Daniel L. Flores 209/466-6781 City of Ripon <br /> John U. Mast. M.O. City Of Stockton <br /> William J. Wade Jopl Khanna, M.O., M.P.N., District Health Officer Clay of Tracy <br /> Mary Anna Love San Joaquin County <br /> San Joaquin County <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS. GEOTECHNICAL DATA AND <br /> S!TE ASSESSMENT INFORMI-1011 <br /> I , the undersigned owner and/or operator of the property and/or facility <br /> located at ��-w2-� <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 /> Owne�/Operator. '(1� Title: <br /> Address C� RX`X <br /> Phone: -tCTS- <br /> (`�!' 4 Crt L 3'o`F <br /> Date: <br /> i u no nc IIrT 1 -1 <br />