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BOARD OF TRUSTEES SAJOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> James Culbertson, Pres. City of Lodi <br /> Patricia E. Vannuccl, Sec'y. 1601 East Hazelton Avenue, P. O. Box 2009 San Joaquin County <br /> Anthonelts Van Spronsan City of Escalon <br /> Earl Plmentel Stockton, Callfornla 95201 City of Manteca <br /> Fern Bupbee 209/g8g.8781 City of Ripon <br /> Daniel L. Flores City of Stockton <br /> John D. Mut, M.D. City of Tracy <br /> William J. Wade Jog] Khanna, M.D., M.P.M., District Health Officer San Joaquin County <br /> Mary Anne 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 facility <br /> located at '43 y S C'- Fre.-7 r S7' SyocKfan if1 $s�)os <br /> hereby authorize =. T CORP. <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 /> Owner/Operator: _�y, �i.�,Xr- { �j t� Title: �l t ���✓t r <br /> Address �/se,� Phone: :;ly 1 SVe-/G 3 y <br /> . S02C."*�2 Cr> 9 sao d' <br /> Date: // —/3 - (r) <br /> EH 08 05 <br />