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BOARD OF IRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> James Culoenson, Pres. <br /> Patricia E. Vannuccl, Sac'y. City of Lodi <br /> Anthonelte Van Spronsen y 1601 East Hazelton Avenue, P. O. Box 2009 San Joaquin County <br /> City of Escelon <br /> Earl Pimentel Stockton, California 95201 City of Manteca <br /> Fern Bugbee <br /> Daniel L. Flores 209/466-0781 City of Ripon <br /> City of Stockton <br /> John D. Mast, M.D. - <br /> City of Tracy <br /> Wlltlam J. Wade Jog[ Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br /> Mary Anne 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 ; o �>G � 110 f,� 'a ��ti � � SC� JJ ��47�.� 5 �� � 0 <br /> hereby authorize ( i�Lli L�'A - k()C,5 ftaya— W <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: Title: ^4/L <br /> Address a&C U Phone: 5 y- <br /> Date: 2'I (S—�y <br /> EH 08 05 UGT 13 ] ' <br />