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BOARD OF IRUSi EES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> James Culbertson. Pres. <br /> Patricia E. Vannuccl, Secy. San Joao City <br /> ' <br /> n County <br /> Anthonette van Spronsen 1601 East Hazelton Avenue, P. O. Box 2009 <br /> City of Eacelon <br /> Earl Plmentel Stockton, Callfornia 95201 City of Manteca <br /> Fern Bupbee 209/466-6781 City of Ripon <br /> Daniel L. Flores _ City of Stockton <br /> John 0. Mast, M.O. City of Tracy <br /> William J. Wade Jog[ Khanna, M.D., M.P.M., District Health Officer San Joaquin County <br /> Mary Anna Love San Joaquin County <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 <br /> hereby authorize ZG�r'� <br /> to release any and all analytical results, geotechnical data and site <br /> dsses_sment 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 /> Owned/Operator: Title: <br /> c^ C7 <br /> Address Phone: <br /> 4 7. ' <br /> Date: " <br /> a r <br /> EH 08 05 UGT 13 13 <br />