Laserfiche WebLink
BOARD OF IRUSIEES SANAOAOUIN LOCAL HEALTH DISTRICT <br /> James Culbertson. Pres, SERVING <br /> Pelrlcle E. Vannuccl, Secy. City of Lod] <br /> Anlhonelle Van Spronsen 1601 East Hazelton Avenue, P. O. Box 2(X19 San Joaquln County <br /> Earl Plmenlel Stockton, California 95201 city of Escalon <br /> Fern Bupoee City of Manteca <br /> Daniel L. Flores 209/466-6781 City of Ripon <br /> John D. Mast, M.D. City of Stockton <br /> City of Tracy <br /> William J. Wade Jopl 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 operator of the property and/or facility <br /> located at S-(113 A /v C Ca-1< plc/ <br /> hereby authorize C44f& Af / a- hcA y., c , �3 t� ryl R 2cf A14j <br /> to release any and all analytical results, geotechnical data and site SS2-40 7 <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: 'c � �' Title: <br /> Address L "/ 13 A f o-C 64 < f Phone: <br /> Date: <br /> EH 08 05 UGT 13 ' <br />