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BOAR <br /> James OF TRUSTEES <br /> James SMOAQLIIN LOCAL HEALTH DISTRICT' Culbertson, Prea. SERVING <br /> Patricia E. Vannuccl, Sac'y City of Lodi <br /> Anthonefte Van Soronsun 1601 East Hazelton Avenue, P. O. Box 2009 San Joaquin County <br /> Fort Plmentel StocktonCalifornia201 Clty of Escaton <br /> , a <br /> Fern Etugbee City of Manteca <br /> Daniel L. Flores 209/466-6781 City of Ripon <br /> John D. Mast, M.D. City of Stockton <br /> William J. Wade Jopl Khanna, M.D., M.P.H., District Health Officer City of Tracy <br /> Mary knna Love San Joaquin County <br /> San Joaquin County <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 <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 /> Owner/Operator: fir Title: r/ <br /> Address Phone: � 5� � <br /> Date: —47 <br /> EH 08 05 UGT 13 <br />