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BOARD OF TRUSTEES SON JOAQUIN LOCAL HEALTH M{ RICT SERVING <br /> James Culbertson, Pres. City of Lodi <br /> Anthonette Van Spronaen ' <br /> Petrlcle Vannuccl, sec'y. 1601 East Hazelton Avenue P. O. Box 2009 San Joaquin county <br /> ttCity of Escalon <br /> Earl Plmontel - Stockton, Callfornla95201 City of Manteca <br /> 'Fern Bupbee <br /> Daniel L. Flores <br /> 209/466-6781 City of Ripon <br /> City of Stockton <br /> John D. M.vsk, M.D. City of Tracy <br /> William J. Wade Jopl Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br /> Mary Anne Love Sen Joaquin County <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> 92o f1 2 . S-fi:"�+Uy- C, 9 s ao 3 <br /> I , the undersigned owner and/or operator of the property and/or facility <br /> located at ,i'S �� < f L-6 / 3 <br /> hereby authorize &r=erSecrr, -x . <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: AA�7„ p�� _ Title: <br /> Address 0. 1730 Phone: <br /> Date: <br /> EH 08 05 <br />