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1 BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> James Culbertson, Pres. SERV <br /> Patricia E. Vannuccl, SecIND <br /> y Coy of ING <br /> Anlhonelte Van Swonsen 1601 East Hazelton Avenue, P. 0. Box 2009 Sen Joaquin County <br /> od I <br /> Earl Pimontel Stockton, California 95201 CITY of Escalon <br /> Darn DL. baa <br /> Daniel . City of Ripon Flores 2()9/466-67$1 Clty of Maniac& <br /> John D. Masi, M.D. City Of Stockton <br /> Mary aryWilliAnne Love J. Wade Jopi Khanna, M.D., M.P.H„ District Health Officer City of Tracy <br /> MASan Joaquin County <br /> 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 1 /400 � t t) <br /> hereby authorize <br /> to release any and all analytical results , geotec ical 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: � � � <br /> Address (Zophone: t��►� r <br /> Date: <br /> EH 08 05 <br />