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80AR0 OF IRUSiECS SAN NQUIN LOCAL HEALTH DISTq T SERVING' <br /> Jsmes Cuiperlaon, Pees. Cur of Lodi <br /> Patriciaih E. v Vanuccl. <br /> Secy. 1601 East Hazelton Avenue . O. Box 2009 San Joaquin County <br /> Anlhonegp Van Spronsen e <br /> Eed Plmeniei Stockton. Callfornia 5201 City of Escelon <br /> Fern Bupase City of Manteca <br /> Daniel L. Florae 209/466-6781 City of Ripon <br /> John f). Mast, M.D. City of Stockton <br /> City of Tracy <br /> William J. Wade Jou! Khanna. M.Q.. M.P.H.. Dlatr! t Health Officer San Joaquin County <br /> Mary Anne Love San Joaquin County <br /> I <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> o <br /> i, the undersigned owner and/or opera r o the r�operty and/or facility <br /> located at <br /> hereby authorize <br /> to release any and all a lytical results, geotec nical data and site <br /> ospessment information to the San Joaquin Local H alth District as soon <br /> as it is available and at the same time it is proided to me or my <br /> representative. - <br /> Owner/Operator: Ti tl e: <br /> Address Phone: -- <br /> Date: _3 <br /> { <br /> EH 08 05 UGT 13 <br />