Laserfiche WebLink
BOARD OF TRUSTEES <br />James Culherlson, Pros <br />Palrlcla E. Vannuccl, Secy <br />Anlhonelle Van Spronsen <br />Earl Plmantel <br />Fern Dupuee <br />Daniel L. Florae <br />John D. Mast. M.O. <br />William J. Wade <br />Mary Anne Love <br />%./ <br />iia , <br />SAN JOAOUIN LOCAL HEALTH DISTRICT SERVING <br />City of Lodi <br />1601 East Hazelton Avenue, P. O. Box 2009 Sen Joaquln County <br />Stockton, Calllornia 95201 City of Escalon <br />City of Manteca <br />209/466-6781 City of Ripon <br />City of Stockton <br />Jopl Khanna, M.D., M.P.M., District Health Officer City of Tracy <br />San Joaquin County <br />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 <br />hereby authorize L.00a4) <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: X �ti�� �l�k Title <br />Address/sc� �/GV y-�,' C/L'. Phone <br />�GG'i r.9 <br />Date: <br />EH 08 05 <br />Qi <br />0 4)A;4eC <br />6.1- /.z /S <br />T!7—C— Fs0 /5 <br />r <br />H <br />