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' • • • • <br /> BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> James Culbertson, Pres. ((��1+h-'�,, City of Lodi <br /> , <br /> Patricia Vannuccl, se1601 East Hazelton AvenuePOBo> � San Joaquin County <br /> Anthonetttte Van Spronsen , P. . City of Escalon <br /> Earl Pimentel Stockton, California 95201 - City of Manteca <br /> Fern Bugbee209/466-6781 },1. - City of Ripon <br /> Daniel L. Flores NEAL'TXACIty of Stockton <br /> John D. Mast, M.D. � ME--4'E Ec, City of Tracy <br /> William J. Wade Jogl Khanna, M.D., M.P.H., District Health Off 1RRt�1.I/ • VIC 'SanJoaquinCounty <br /> Mary Anna Love FE. 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 /0 6-6 / �v !N4 /h le f r 0 rlo <br /> hereby authorize Ca �o�r! 'a �fpN � �ornfcry <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: 7" ,Vyyt v �_ Title: b cJ YI 2 r <br /> Address o Phone: )o9- <br /> I <br /> �.a )0 I1LlUf-� r C) cJ 0 <br /> Date: ZL <br /> EH 08 05 <br />