Laserfiche WebLink
OF TRUSTEES <br /> James Culbertson. Pres. S'x�•,,JOAQUIN LOCAL HEALTH DIl5TRICT SERVING <br /> James <br /> Patricia E. Vannuccl, Secy. City of Lodl <br /> Anthonette Van Spronsen 1601 East Hazelton Avenue, P. O. BOX 2009 San Joaquin County <br /> Earl Pimentel Stockton, California 95201 City of Escalon <br /> Fern Bupbae 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 /> s <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 —Kl_ I► ylafLzYee & PS ie� TS <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 /> e 1fiY Sr->Tl <br /> Owner/Operator: ,o nh L R00CjfEL Title: Cull <br /> i <br /> Address -42-E3 Llo a F�, I azA-C>tj _Phone: <br /> Date: <br /> L1�/fjy Lx. N-ri4c-r ree.&dd <br /> rN ;;R CS <br />