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SOARO Of TRUSTEES SAN , AQUIN LOCAL HEALTH DISTP T SERVING' <br /> James CulDansorr. Prae. Clly of Lodi <br /> Fairicla E.Vannuccl. Secy. __1601 East Hazelton Avenue, P. 0. Box 2009 San Joaquin County <br /> Anlhonstle Van Spronsen - City of Escaton <br /> Earl Plmentel Stockton, Catlfornia 95201 City of Manteca <br /> Fern Bupoee 209/466-6781 City of Ripon <br /> D--'M L. Flores City of Stockton <br /> J. D. Mast, M.D. City of Tracy <br /> Wl11flam J. Wade Jopl Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br /> Mary Anna Love San Joaquin County <br /> 1 <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 <br /> hereby authorize Cp(ifo{nia Wafer �abara �or�' <br /> to release any and all analytical results, geotechnical data and site <br /> es$essment information to the San Joaquin Local Health District as soon <br /> it is available and at the same time it is provided to me or my <br /> representati ve. <br /> Owned/Operator: *ir Title: <br /> Address /9a 0 Ca/i fer)l i et S f. � Phone: Y3 ?-.15'31 <br /> £scaloh C'A <br /> Date: /.Z/.3o <br /> �or <br /> t ESCa�o�. f'rs �sre/n��J i� �ozf c4mc/- <br /> EH 08 05 UGT 13 <br />