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e0AR,0 Of TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> . James Culbertson, Pres. SERVING <br /> Patricia E. Vannuccl, Secy Clly of Lodi <br /> Anthonelte Van Spronsen 1601 East Hazelton Avenue, P. O. Box 2009 San Joaquin County <br /> Earl Plmentel Stockton, California 95201 CITY of Escalon <br /> Fern Dupoee City of Manteca <br /> Daniel L. Flores 209/466-6781 City of Ripon <br /> John D. Mast, M.D. City of Stockton <br /> William J. Wade Jopl Khanna, M.D., M.P.H., District Health Officer City of Tracy <br /> Mary Anna Love San 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 _ C-- <br /> hereby <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 /> Owns . Operator LV—L-r_:F- p Title: y� C y t uDh t \ <br /> Address PQ. Qnx is9C1 Phone: 0) - (_ ,4,2 _ i.ZS-1 <br /> Date: a•(o- g(o <br /> AUG 12 Mb <br /> ENVIROMENTAL HEALTH <br /> PERMIT/SERVICES <br /> EH 08 05 • <br />