Laserfiche WebLink
Biir ++.D OF TRUSTEES <br />1 James Culbeoson, Pres. <br />Mary Anna Love, Vice Pros. <br />Patricia E. Vannuccl, Secy. <br />Tommy Joyce <br />Earl Pimentel <br />Virginia Mathews <br />Daniel L Flores <br />John D. Mast, M.O. <br />Gene S. Kraham <br />SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br />City of Lodi <br />1601 East Hazelton Avenue, P.O. Box 2009 San Joaquin County <br />San Joaquin County <br />Stockton, California 95201 Ctty of Escalon <br />City of Manteca <br />(209) 466-6781 City of Ripon <br />City of Stockton <br />Jogi Khanna. M.D.. M.P.H.. District Health OMtcer City of Tracy <br />San Joaquin County <br />AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br />SITE ASSESSMENT INFORMATION <br />I, the undersigned owner 5d/or operator of -the property and/or facility <br />located at r '710 /,,,�����^G r7j (f/4CO'ik cQG <br />hereby authorize <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/Op <br />Address <br />Date: <br />EH 08 05 UGT 13 <br />Title:/ <br />Phone: ;73 457 <br />