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Y <br /> BOARD OF TRUSTI=ES SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> James Culbertson, Pres. SERVlN <br /> Patrlcla E. Vannuccl, Secyt) <br /> 00. City of Lodl <br /> ef <br /> Anthonette Van Spronson 1601 East Hazelton Avenue, P. O. Box 2SuooaCalifornia959 San Joaquin County <br /> Earl Stockton, 201 City of Escalon <br /> Fern Qped city of Manteca <br /> Dante! L. Flores 20/466-6781 City of Ripon <br /> John D. Mast, M.D. City of Stockton <br /> William J. Wade JoQI Khanna, M.D., M.P.H., District Health Officer City of Tracy <br /> Mary Anna Lova San Joaquin County <br /> San Joaquin County <br /> III <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE <br /> ASSESSMENT INFORMATION <br /> ILI j <br /> eI , the undersign owner and/or oper or f the and/or facile <br /> t <br /> located at O yl <br /> I <br /> hereby authorize <br /> to release any and all analytical results , geotechnical data <br /> and site <br /> assessment information to the <br /> San Joaquin Local Health District'k 1ct as soon 'I <br /> as it is available and at the same time it is provided to me or my ;I <br /> representative. <br /> P/4 Owner/Operaator Title: <br /> Address <br /> L7 Phone: <br /> a <br /> E Date: <br /> t <br /> EH 08 05 <br />