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. • i <br /> SERVING <br /> OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT City of Lodi <br /> James Culbertson, Pres. San Joaquin County <br /> Patricia E. Vannuccl, Secy. 1601 East Hazelton Avenue, P. O. Box 2009 City of Escalon <br /> Anthonette Van Spronse(1City of Manteca <br /> Earl Plmenlel Stockton, California 95201 City of Ripon <br /> Fern Bugbee 209/466-6781 City of Stockton <br /> Daniel L. Flores City of Tracy <br /> John D. Mast, M.D. San Joaquin County <br /> William J. Wade Jogl Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br /> Mary Anna Love <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> I , the undersigned owner and/or 9(p)erator of the property and/or facility <br /> located at Sol3 OV1 i�+J IKQ , Ccrn� tr rn CR qS <br /> hereby authorize eeilw PrTEQ. A� Yn C'TY CA <br /> to release any and all analytical results, geotechnical data andsite <br /> o A <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: 7 " Title: C90' <br /> ;6 <br /> pe Phone: PybD 6 z68 <br /> Address J*7.3 / I�/ewy !1 <br /> S Ta C <br /> Date: //Z/0 <br /> � c � <br /> .e " <br /> EH 08 05 <br />