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BOARD OF TRUSTEES �� <br /> S N JOAQUIN LOCAL HEALTH DIGRICT / SERVING <br /> James Culbertson, Pres. City of Lodi <br /> Patricia E. Vannuccl, Sec'y. San Joaquin County <br /> Anthonette Van Spronsen 1601 East Hazelton Avenue, P. 0. Box 2009 City of Escalon <br /> Earl Pimentel Stockton, California 95201 city or Manteca <br /> Fern Bugbee 209/466-6781 City of Ripon <br /> Daniel L. Flores City of Stockton <br /> John D. Mast, M.D. City of Tracy <br /> William J. Wade Jogl Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br /> Mary Anna Love 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 3l /( e«-7- <br /> hereby authorize f:cJCI 2 >�u e7L <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: I�aFr� <br /> Address 3931. Newton Road , Phone: (209) 948-6268 <br /> Stockton , CA <br /> Date: 8- 19-86 <br /> EH 08 05 <br />