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SERVING <br /> BOARD OF TRUSTEES Sq JOAQUIN LOCAL HEALTH DI ICI City of Lodl <br /> James Culbertson, Pres. San Joaquin County <br /> Patricia E. Vannuccl, Soc'y. 1601 East Hazelton Avenue, P. O. Box 2009 City of Escalon <br /> Anthonette Van SpronsonCity of Mantoca <br /> Earl Plmantel Stockton, California 95201 City of Ripon <br /> Fern eugbea 209/466-6781 City of Stockton <br /> Daniel L. Flores City of Tracy <br /> John D. Mast, M.D. San Joaquin County <br /> William J. Wade Jogi Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br /> Pilary Anna Love - <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> I , the undersigned own and/ r operator of the property and/or facility, <br /> located at -51LX <br /> Sx-r <br /> hereby authorize `� p eotechnical data and site <br /> to release any and all analyti .sults, g <br /> alth District as soon <br /> assessment information to the San Joaquin Local he <br /> as it is available and at the same time it is provided to me or my <br /> representative. yy <br /> Title: w1 '� ' <br /> Owner/Operator: <br /> A �,�� Phone: <br /> Address - "_ <br /> Date: <br /> Ell 08 05 <br />