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a <br /> BOARD of 1AUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVI dO <br /> Jamea cult,anson. Pres• City of Lodi <br /> lficia E. Vannucti, Sec'y San Joaquin County <br /> 6 1601 East Hazellon Avenue, P. O. Box 2009 city 01 Escaton <br /> lhonaiia Van Spicnsan <br /> Eari ptmanial Siocklon, Cailtcfnia 95201 City of Manteca <br /> Fern BugtGau 209/466-6781 City <br /> St Atpon <br /> Danl..f L. F101e9 ty ockton <br /> John 1]. Mast, M.O. Cit Stty oI Tracy <br /> Wlllf�jm J.wade Jopl Khanna, M.D., M.P.H.,Ofatfict Health Officer San Joaquin County <br /> Mary Anna Lore 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 bb <br /> hereby authorize 16; <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: Title: U `'yam <br /> Address Phone: <br /> I.o 5 <br /> Date: \`7-\Ck- <br /> Ffl nn nS IIGT 3 <br />