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r i <br /> uOARD of IRust l.lS SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> James Culbertson, Pres. SERVING <br /> Patricia E. Vanr,UCcl, SeC'y City ollOdi <br /> Anthunette Van Spronsan 1601 East Hazelton Avenue, P. O. Box 2009 San JoaQuln Counly <br /> Earl Punonlal Stockton, California 95201 city of Escalon <br /> Fern Bupuae City of Manteca <br /> Daniel L. Flores 209/466-6781 City of Ripon <br /> John D. Mast, M.D. City of Stockton <br /> William J. Wade Jog( Khanna, M.D., M.P.H., District Health Officer City of Tracy <br /> Mary Anna Love 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 .t, o/ LJ� LCO,,,d <br /> hereby authorize C'QL-1!7 <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 /> Ownef/Operator: Title: 6.0� <br /> Address 0 IF Phone: Co <br /> �� S Z <br /> Date: / <br /> r <br /> EH 08 05 UGT 13 <br />