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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISI RICT SERVING <br /> City of <br /> James Culbertson, Pres. <br /> Patricia E. Vannuccl, Secy. 1601 East Hazelton Avenue, P. O. Box 2009 San Joaquin County <br /> Anthonette Van Spronsen City of Eacalon <br /> Earl Pimentel Stockton, California 95201 City of Manteca <br /> of <br /> Fern Bugbee 209/466-6781 City of StyofSton <br /> occktkton <br /> Daniel L. Flores City of Tracy <br /> dvim D. Mast, M.D. <br /> William J. Wade Jog[ 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 roperty and/or facility <br /> located at <br /> hereby authorize <br /> to release any and all a alytical 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: DisT, hoJ ,"Av <br /> Address 2-1/0 Phone: 2a9-rjs /fb'3 <br /> Date: i2-- 30-YY <br /> EH 08 05 <br />