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BOARD OF 1RUSTEES SANRAQUIN LOCAL HEALTH DISTST <br /> SERVING <br /> Jame3 Cutbertson. Pres. Clly of Lodi <br /> Patricia E. Vannucct, Sec"y. Joaquin San Joa <br /> AnlhorTatle Van Sp(onsen 1601 East Hazelton Avenue, P. 0. Box 2009 q County <br /> calon <br /> Earl Plmentel Slocklon, California 95201 City <br /> tyOfty Eanteca <br /> Fern Bugbee Clty of Manteca <br /> Danlef L. Flores 209/466$781 City of Ripon <br /> John D. Mast, M.D. City of Stockton <br /> City of Tracy <br /> William J. Wade Jogl Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br /> Mary Anna Love 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 / i'(,��I)lAye <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 tune it is provided to me or my <br /> representative. <br /> Owner/Operator:, Title: <br /> Address Phone <br /> Date: - � <br /> EM 08 05 UGT 13 <br />