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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> James Culbertson, Pre$. City of LodI <br /> Patricia E. Vannucci, 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 Bugbee 209/466 6781 City of Rlpon <br /> Daniel L. Flores City of Stockton <br /> Suhn D. Mast, M.D. City of Tracy <br /> William J. Wade Jogl Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br /> Mary Anna Love 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 facilitypp �� <br /> located at `V6C��� <br /> + n <br /> b74A Pzkn! <br /> hereby authorizeX10. (,()c2t b Cau" <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. ,f <br /> Owner/Operator: $ (,� Title: �i�+' li 141!r <br /> Address Phone: <br /> '91 c(: d ca <br /> Date: <br /> EH 08 05 <br />