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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> City of <br /> James Culbertson, Pres. <br /> Patricia E. Vannuccl, Secy. 1601 East Hazelton Avenue, P. O. Box 2009 Sen Joaquin County <br /> City Escalon <br /> Anthonette Van Spronse� <br /> Earl Plmentel Stockton, California 95201 city off Manteca <br /> Fern Bugbee 209/466-6761 y Citof Stockton <br /> of Ripon <br /> Daniel L. Flores Cltt <br /> John D. Mast, M.D. y 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 /> 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 R- ,.Oy IS4_ 4/(� YY-�Q44G:�-CA- QA' ') 533 <br /> hereby authorize CALI>r • VJI:A-"4Z- )—� Y1r1()OLS17D CQ <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 . ���I ^ — Title: 2 <br /> Address Phone: <br /> Date: <br /> t1: <br /> EH 08 05 <br />