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dioAFio of 1RUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> fames Culbertson. Pres. City ofLodl <br /> Patricia E. Vannuccl, Secy 1601 East Hazelton Avenue, P. O. Box 2009 Sen Joaquln County <br /> Anthonelte Van Spronsen City of Escalon <br /> EGfl Plmenlel Slockton. California 95201 City of Menleca <br /> Fern augoee 209/466-6781 City of sipon ' <br /> Danlel L. Flores City of Stockton _ <br /> John D. Mast. M.D. ;i City of Tracy <br /> William J. Wade Jogl Klwanna. M.D.. M,P.H.. Dialricl Health Officer San Joaquin County <br /> Mary knna 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 303 N. Pilgrim, Stockton, CA <br /> hereby authorize Canonie Environmental Stockton CA <br /> to release any and all analytical results, geotechniical 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: J <br /> -_ Title: <br /> Address <br /> Phone: �lr' <br /> Hate: <br /> i <br /> • 1 <br /> . I <br /> I! <br /> F <br /> FH 08 05 UGT 13 <br />