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;e0AR0 car TAUStEEs SAN•AOUIN LOCAL HEALTH DISTRICTJ.maa Culbenson, Pres. SERVING <br /> Patrtcl• E. Vannuccl. Sec*y. City of Lod( <br /> Anthonette van Spronsen 1601 East Hazelton Avenue, P. O. Box 2W9 San Joaquin County <br /> Earl felmentel Stockton, California 95201 City of Escalon <br /> Fern Bupose _ _ city of Manteca <br /> Daniel L. Flores 209/466-6781 City of Ripon <br /> John O. Mast, M.O. City of Stockton <br /> William J. Wadi, Jopl Khanna, M.O., M.P.H., District Health Offlcer City o1 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 /> 1 , the undersigned owner,-and/or operator of the property and/or facility <br /> located at <br /> r. <br /> hereby authorize <br /> to release any and all analytical results, geotechnical data and site <br /> assessment inforno tion 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:,. � Title: Y <br /> Address �jg._ ZU. czk2 Phone: gr�7 — 79z7 <br /> Date: <br /> Ell 08 05 UGT 13 r <br />