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BOARD OF TRUSTEES .SOJOAQUIN LOCAL HEALTH DI-4ICT SERVING <br /> James Culbertson, Pres. City of LodI <br /> Patricia E. Vannuccl, Sec'y. San Joaquin County <br /> Ant to van Spronsen - 1601 East Hazelton Avenue, P. O. Box 2009 City of Escalon <br /> Earl Pimentel Stockton, California 95201 city of Manteca <br /> Fern Bupbee 209/466-6781 Ripon <br /> Daniel L. Flores City <br /> oof f St <br /> ockton <br /> John D. Mast, M.D. City of Tracy <br /> William J. Wade Jogi 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 ."" ',/ L' <br /> hereby authorize <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: y�. %% • — <br /> Address 3931 Newton Road , Phone: (209) 948-6268 <br /> Stockton , CA <br /> Date: 8- 19-86 <br /> EH 08 05 <br />