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0 0 <br /> BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> James Culbertson, Pres. City of Lodl <br /> Patricla E. Vannuccl, Sec'y San Joa uln <br /> Anthonette Van Spronsen 1601 East Hazelton Avenue, P. O. Box 2009 City <br /> County <br /> y of Eacelon <br /> Earl Plmenlel Stockton, Callfornia 95201 City of Manteca <br /> Fern Bupbee 209/466-6781 City of Ripon <br /> Daniel L. Flores City of Stockton <br /> John D. Mast, M.D. City of Tracy <br /> William J. Wade Jopl Khanna, M.D., M.P.M., 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 p perty and/or facility <br /> located at 0 st� Lm & <br /> hereby authorize J Q <br /> to release any and all analytical resul s, 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: 10D . D11 <br /> Title: <br /> Address Phone: y <br /> Date: <br /> EH 08 05 UGT 13 <br />