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eOxRC. of)RUStEES <br /> SAN JC` ")UIN LOCAL HEALTH DISTRICT SERVING <br /> �.a <br /> City of Lodi <br /> James Culbertson. Pres. - Sen Joaq uln County <br /> Palacia E: Vannuccl. Secy. 1601 East Hazelton Avenue, P. O. Box 2009 City of Escalon <br /> Anthonetls Van Spronsen Cit of Manteca <br /> Earl Pimenlel SIOCI(len, Catllornia 95201 r <br /> City of Ripon <br /> Fern Bupbae 2091466-6781 City of Stockton <br /> Daniel L. fiords City of Tracy <br /> John D: Mast, M.O. <br /> William J. Wade Jo01 Khanna, M.D., M.P.H., District Hddilh Officer San Joaquin County y <br /> San Joaquin Courtly <br /> Mary Anne Love . <br /> Crk <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND ; :AY � �^✓ � <br /> SITE ASSESSMENT INFORMATION ? fNTAi HEliTy <br /> 1T/Q_FYlc�s <br /> I , the undersigned owner and/or operator of the ppr�opert/y and/or facility <br /> located at /-26/ ���/ �� <br /> hereby authorize <br /> to release any and all arta ytical results, geotechnical data and site <br /> dssessment 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/Operator <br /> �J . Title <br /> Address n n <br /> Phone. q(a(n— �3 <br /> — <br /> ' Datt� ��/•� �� <br /> ORIGINAL <br /> a <br /> EH 08 05 UGT 13 <br />