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OF 1Russ <br /> JamesAMe3 CulSAN JOAQUIN LOCAL HEALTH DISTRICT <br /> henaon. Pres. - SER VINO <br /> Patricia E. Vannuccl, Secy City of ING <br /> odi <br /> Anthonetle Van Spronsen 1601 East Hazelton Avenue, P. O. Box 2009 Sen Joaquin County <br /> Earl Plmantel Stockton, California 95201 City of Escalon <br /> Fern Rupoee City of Manteca <br /> Daniel Flores 209/466-6781 City of Ripon <br /> John D.. Meat, M.D. City of Stockton <br /> William J. Wade Jopl Khanna, M.D., M.P.H., District Health officer City of Tracy <br /> Mary Anna 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 ^f l°mi9 E�e tre Sr- <br /> hereby <br /> Thereby authorize CfA10A11 TcA14I <br /> to release any and all analytical results, geotechnicaldataand 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. n <br /> Owner/Operator: Title: <br /> Address cis Phone:�ye�� <br /> Date: <br /> EH 08 05 <br />