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RECICEtVED NOV 1 2 1985 <br /> BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> James Culbertson, Pres. City of Lodi <br /> Patricia E. Vannucci, Secy. 1601 East Hazelton Avenue, P. O. BOX 29 San Joaquin County <br /> Anthonette Van Spronsen 00City of Escalon <br /> Earl Pimentel Stockton, California 95201 City of Manteca <br /> Fern Bugbee209/466-6781 City of Ripon <br /> Daniel L. Flores City of Stockton <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 D San Joaquin County <br /> 1985 <br /> ENVIRC rpt v SAL HEALTH <br /> F Fr "?1-/SERVICES <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 ;21001N E//o If o/ /0 k,,�o�r/, C�i� Y,rz3y <br /> hereby authorize 0. rr. i`laler.a'/r �. 2,900 <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: <br /> Address V.s Dep '577 "'577 �- ,1.41 e�-6,/ .�«.�r�, Jew . Phone: <br /> /(�� e19 yrzlr <br /> Date: 6/1 'et � <br /> EH 08 05 <br />