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BOARD Of 1RUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> SERVING <br /> Jame, CUIDerl3on, Pres. <br /> Patricia E. Vannuccl, Secy City of Lodi <br /> Anlhonette Van Sproneen 1601 East Hazelton Avenue, P. O. Box 2009 San JoaQuln County <br /> Earl Plmentel Stockton, Calltornia 95201 tEa <br /> CCiIy off Meniacsleca <br /> Fern Buyu <br /> Daniel L Flores 209/466-6781 City of Ripon <br /> City of Stockton <br /> John 0, Mast. M.D. <br /> City of Tracy <br /> William J. Wads Jopl Khahns, 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 erty and/or facility <br /> located at to Fpe'j <br /> hereby authorize <br /> to release any and all analytical results , ge ethnical 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: 11 c c 2Czw� Title: r)11,11-7 _ <br /> Address �( 0 L Phone: YUP <br /> Date: a� <br /> EH 08 05 UGT 13 <br />