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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> James Culoerlson, Pres. <br /> y of Lodi <br /> Patricia E. Vannuccl, Secy San Joaquin County <br /> Anlhonelle Van Spronson 1601 East Hazelton Avenue, P. O. Box 2009 q <br /> Earl Plmenlel Stockton, Callfornia 95201 city f Eacalon <br /> City of Manteca <br /> Fern eupoea 209/466-6781 City of Ripon <br /> Daniel L. Flores <br /> City of Stockton <br /> John D. Mast, M.D. City of Tracy <br /> William J. Wade Jopl 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 315 N. Main Street, Lodi , CA 95240 <br /> hereby authorize Canonie Environmental <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 /> Owner/Operator: Title:PV <br /> Address Phone: <br /> Date: -jat <br /> EH 08 05 UGT 13 <br />