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BOARD OF TRUSTEES c - N ,,,QUIN LOCAL HEALTH D..f R� SERVING <br /> James Culhertson. Pres. �,.� Clly of Lodl <br /> Palricla E. Vannuccl, Secy, <br /> Anlhonelle Van Sro ep^ 1601 East Hazelton Avenue, P. O. Box 2009 San Joaquln County <br /> J/�/ City of Escalon <br /> Earl Pimenlel Stockton, Callfornia 95201 City of Manteca <br /> Fern L. <br /> Flores 209/466-6781 City of Ripon <br /> ugbee <br /> Cit <br /> Daniell LL. Floras of Stockton <br /> John D. Mast, M.D N/J 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 /> 0 <br /> NN SEP 10 1986 TF}� <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL ED AthOSERV CEAL LL °`' <br /> SITE ASSESSMENT INFORMATIONJ �_ a o <br /> I , the undersigned owner and/or operator of the property and/or facility <br /> located at 6(9 ga, C Kt✓TT�� F �Rri L)p <br /> hereby authorize di /t), 7-014 LAS <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. Q �1 <br /> Owned/Operator: L A Title: <br /> Address eX3 <br /> Phone 3 t.(c 7 3 <br /> Date: <br /> i <br /> EH 08 05 UGT 13 ' <br />