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BOARD (iF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> James Culbertson. Pres. City of Lodl <br /> Patricia E. Vannuccl. Secy San Joaquin County <br /> Anthonette Van Spronsen 1601 East Hazelton Avenue, P. O. Box 2009 <br /> City of Escelon <br /> Earl Plmentel Stockton, California 95201 City of Manteca <br /> Fern Bupbee 209/466-6781 City of Ripon <br /> Daniel L. Flores City of Stockton <br /> John O. Mast, M.D. City of Tracy <br /> William J. Wade Jopi 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 facility <br /> located at , d' --6 <br /> hereby authorize Canonie Environm ntal <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 /> Owne /Operator- L/a Title: V <br /> Address Phone: <br /> Date: <br /> EH 08 05 UGT 13 <br />