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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> City of Lodi <br /> James Culbertson, Pre$. San Joaquin County <br /> Patricia E. vannuccl, Secy. 1601 East Hazelton Avenue, P. O. Box 2009 City of Eecalon <br /> Anthonette Van Spronse[♦ Cit of Manteca <br /> Earl Pimentel Stockton, California 95201 City <br /> yof Ripon <br /> Fern Bupbes 209/466-6781 City of Stockton <br /> Daniel L. Flores City of Tracy <br /> John D. Mast, M.D. <br /> William J. Wade Jopi Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br /> San Joaquin County <br /> Mary Anna Love <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 .2O SO -7 AV-;WS <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 /> 16 representative. <br /> Owner/Operator: c Title: �/,lJ/1/file- <br /> Address E S r Phone: 83�- Ido/f7 <br /> Date: )7— /p— p 0 <br /> e <br /> EH 08 05 <br />