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V SERVING <br /> BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT City of Lodl <br /> James Culbertson, Pres. San Joaquin County <br /> Patricia E. Vannuccl, S90y. 1601 East Hazelton Avenue, P. O. Box 2009 City of Escalon <br /> City of Manteca <br /> Anthonetts Van Spronsed <br /> Earl Plmentel Stockton, Callfornla95201 City of Ripon <br /> FernBupbee 209/466-6781 City Stockton <br /> Daniel L. Flores City of Tracy <br /> John D. Mast, M.D. <br /> William J. Wade Jopl Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br /> San Joaquin County <br /> Mary Anne Love <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> I , the undersigned owner and/or oper`ator��/Qf the property and/or facility <br /> located at ( f� <br /> hereby authorize _ //(T � r �N <br /> YYI�'nFSQ D <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 /> I representative. <br /> i <br /> Owner/Oper or: \ Title: <br /> Ad0ess X I �—, C-7 phone: 90 <br /> Date: Q 9 <br /> i <br /> EH O8 05 <br />