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BoARo of TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> James Culbertson, Pros. SERViN4 <br /> Patricia E. Vannucci, Secy- City of Lod! <br /> Anlhonatte Van Spron3an 1601 East Hazelton Avenue, P. O. Box 2009 <br /> 'San Joaquin County <br /> Earl Pimentei StoCkton, California 95201 City of Escaion <br /> Fern Bugbee City of Manteca <br /> Daniel L. Flores 209/466-6781 City of Ripon I <br /> John D. Mast, M.D. CltyofStockton <br /> William J. Wade Jopl Khanna, M,D., M.P.N., District Health Officer City of Tracy <br /> Mary Anna Love San Joaquin County <br /> San Joaquin County i <br /> I <br /> I <br /> I <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> l <br /> I , the undersigned owner and/or operator of the property and/or facility <br /> located at ell /(140 <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 /> I <br /> M <br /> Owner/Operator: <br /> Title: P41I4A) lT �nIgiN&�-c:,2 <br /> Address / ��/ �c1U, ]�� <br /> f, CY Phone: <br /> Date: " �— <br /> I <br /> I <br /> . C <br /> i, <br /> EH 08 05 �i <br />