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eoAAo or TRUSTEES SAN JOAOUIN LOCAL. HEALTH DISTRICT <br /> Jame Cutt,ertaon. Pres. SERVINO <br /> Patrlcle E. Vannuccl, Secy. Clly of Lodl <br /> Anlhonette Van SP(onsen 1601 East Hazelton Avenue, P. O. Bou 2009 San Joaquin County <br /> Emit Pimentel Stockton. California 95201 City of Eacalon <br /> Fern BuoOee Clly of Manteca <br /> Daniel L. Flores 209/466-6781 City of Ripon <br /> John 0. Ma3t. M.O. ��, _ City of Stockton <br /> William J. Wade Jogl Khanna. M.O.s M.P.N., District Health Officer '_c City of Tracy <br /> Mary Anna Love San Joaquin County <br /> � � San Joaquin County <br /> ENVIROMENTAL HEALTH <br /> F ERMIT/SERVICES <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 6. <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/Operator: Title: ,4-- — <br /> Address _ Phone: <br /> 49 <br /> t- <br /> r — <br /> Date: 11---- Z .�l - <br /> Eli 08 05 UGT 13 <br />