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�4. <br /> SERVING <br /> BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT City of Loaf <br /> James Culbertson, P18- San Joaquin County <br /> n <br /> Patricia E. vanuccl, Secy 1601 East Hazelton Avenue, P. O. Box 2009 City of Escalon <br /> Anthonette van SpronsenCity of Manteca <br /> Earl Pimentel Stockton, California 95201 City of Ripon <br /> Fem Bugose 209/466-6781 City of Stockton <br /> Daniel L. Flores City of Tracy <br /> John D. Mast. M.D. M.D., M.P.H., District Heafth Officer San Joaquin County <br /> William J. WailsJopl Khanna, San Joaquin County <br /> Mary Anna Love <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 5606 Pacific Avenue Stockton <br /> hereby authorize J.H. Kleinfelder & Associates <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: <br /> ./yam CT Title: l' . �; •✓ = �. E� <br /> Phone: (,.z— <br /> Address Address • '� -" ^"�� <br /> , � <br /> / .St.✓ . C i'E.c tic' � <br /> Date: =�•% <br /> EH 08 05 <br />