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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> James Culbertson, Pres. City of Lodi <br /> Patricia E. Vannuccl, Secy. 1601 East Hazelton Avenue, P. O. Box 2009 San Joaquin county <br /> Anthonette Van Spronsen City of Eacalon <br /> Earl Pimento] Stockton, California 95201 City of Manteca <br /> Fern Bugbee 209/466-6781 City Ripon <br /> Daniel L. Flores Citof Stt ockton <br /> John D. Mast, M.D. City of Tracy <br /> William J. Wade Jogi 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 ope ator of the property and/or facility <br /> located at 3 <br /> hereby authorize <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: OVi p i Title: <br /> Address 9 Phone: 6 � 0� <br /> Date: /!-/- !S0� <br /> EH 08 05 <br />