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1 <br /> i <br /> e0 OF IRUST EES SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> SERVING <br /> Jame3 Culbertson. Pres. City of Lodl <br /> PalriAnth la E. V Vanuccl, <br /> Sen 1601 East Hazelton Avenue, P. 0. Box 2009 San Joaquin County <br /> Anitionette Van Spronsen <br /> Ion <br /> Earl Vlmenlel Stockton, Callfornia 95201 City f Mansc ateca City or Menlece _ <br /> Fern Bupbee <br /> Daniel L. Flores 209/466-6781 city or Ripon <br /> City of Stockton <br /> John 0. Mast, M.O. City of Tracy <br /> William J. Wade Jogf Khanna, M.O., M.P.H.. District Health Offlcer 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 235 k/ <br /> hereby authorize <br /> r <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 /> Owned/Operator: C �p/� Ti t e: <br /> Address a,r3 VY, /�R��y/ Phone: 20,�? <br /> Date: 2 — /3 —kZ <br /> Ft <br /> D FFR1 �. , <br /> ENVIROMENIAL HEALTH <br /> F ERIAIT/SERVICES <br />