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SERv1N0 <br /> BOARD of TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT City of Lodi <br /> James Culbertson, Prea. San Joaquin County <br /> Patricia E. vannuccl, Secly. 1601 East Hazelton Avenue, P. 0. Box 2009 city of Eacalon <br /> Anthonette van Spronse� City of Manteca <br /> StOCi(tOn, California 95201 City of Ripon <br /> Earl Pimenlel <br /> Fern Sugbee 209/466-6781 City Stockton <br /> Daniel L. Flores City o!Tracy <br /> Jahn D. Mast, M.D. San Joaquin County <br /> William J. Wada Jogi 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/orerator of the property and/or facility <br /> located at 9 1t�wj ua V'Q , S $ <br /> f c"v Gj <br /> hereby authorize �l_E <br /> ci _ <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/0perator: �"` Title: Dc--"•c `� <br /> Phone: <br /> Address j v64� uy <br /> e- �yb9 6 ZG� <br /> s <br /> 7-0 C <br /> Date: <br /> EH 08 05 <br />