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BOARD OF TRUSTEES SAN OAQUIN LOCAL HEALTH DISTr"f, CT <br /> Janne, Culbertson. Prat. SERVING <br /> Pslrlcla E. Vannuccl, Secy. City of Lodi <br /> Anlhonell• Van SPronsen 1601 East Hazelton Avenue, P. O. Box 2009 San JoaQuln County <br /> Earl Pimenlel Stockton, California 95201 City of Escaton <br /> Fern Sugbee 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 Jo I Khanna, M.D.. City of Tracy <br /> 0 4 M.P.H., District Health Officer a <br /> Mary Anna Love � �p- JR G1�In county <br /> ln County <br /> '4 <br /> JUN g lg,,._. <br /> ENVIROMENTAL HFALFH <br /> FERMIT/SERVILS <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 rp'iz5 Errnr�, nYnl 11 <br /> hereby authorize -Zurrkck Lu6ore�Ori �KI L., (I q% U r1�+P40 <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 /> Owned/Oper4jtor: /�� ti %121 „ Title: <br /> Address �(,' � £!Nr/J k r � Phone: -7 <br /> Date: '����/( (t/ <br /> EH 08 05 UGT 13 3 a <br />