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BOARD OF TRUSTEES - - N JOAQUIN LOCAL HEALTH DhRICT SERVING <br /> James Culbertson, Pres . City of LodI <br /> M Palrlcla E . Vannuccl , Secy. 1601 East Hazelton Avenue , P. O . Box 2009 San Joaquin County <br /> Anthonette Van Spronsen City of Escalon <br /> Earl Plmentel Stockton , California 95201 City of Manteca <br /> Fern Bupbee 209/ 466-6781 Clly of Ripon <br /> Daniel L. Flores City of Stockton <br /> John D. Mast , M . D. City of Tracy <br /> William J . Wade JoUlKhann(a,. M . D.,; M. P. H: 151s'lrictHealth Officer San Joaquin County <br /> Mary Anna Love T ' � j, ' . San Joaquin County <br /> TN <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 2050 C, Wc-644.D (N ( S77 <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 . ` 1 <br /> Owner/ Operator : b a\n\ e,1 pyjvC)0wnT Title : v, $ In( <br /> Address 2050 UZ , lFiZ_C—IMO N7 Phone : 466 43S (o <br /> 111�G� � , CfYI� F C( 52z�S <br /> Date : <br /> EH 08 05 <br />