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SAN JOAQUIN LOCAL HEALTH DIS-(RICT SERVING <br /> BOARD OF TRUSTEES City of Lodi <br /> James Culbertson, Pres. San Joaquin County <br /> Patricia E. Vannuccl, Selly. 1601 East Hazelton Avenue, P. O. BOX 2009 City of Escalon <br /> Anthonette Van Spronsen Stockton, California 95201 City of Manteca <br /> Earl Plmentel City of Ripon <br /> Fern Bugbee 209/466$781 City of Stockton <br /> Daniel L. Flores City of Tracy <br /> Join D. Mast, M.D. <br /> William J. Wade Jog] Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br /> 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 operator of the property and/or facility <br /> located at %� 2 _-2 — <br /> hereby authorize j?Z,1'se <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: Title: <br /> Address 1�i9 Phone: gy7/ <br /> Date: <br /> EH 08 05 <br />