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eOAR0 OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> James CulDertaon, Pres. SERVING <br /> City of Lodi <br /> _ ,Patricia E. Vannuccl. Secy 1601 East Hazelton Avenue, P. O. Box 2009 San Joaquln Count <br /> Anthonette Van Spronaen y <br /> Earl Plmentel $fOCktOn, California 95201 Cltyof Eacalon <br /> Fern Bugoee, City of Manteca <br /> Danlel'l. Flores 209/466-6781 City of Ripon <br /> City of Stockton <br /> John D. Mast, M.D. . Clly of Tracy <br />' William J. Wade Jopl Khanna, M.D., M.P.H. Dlelrlcf Health Officer Sen Joaquin County <br /> Mary ,nna Love <br /> San Joaquin County <br /> a <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 X260 S. Main Street, Manteca, CA <br /> Environmental , Stockton, CA <br /> hereby authorize Canonie <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: Z rJr/0 Title: 0f/I/h e/2 <br /> Address Q Phone: 1/,j 186-04_3y <br /> Date: __ <br /> i <br /> r• <br />