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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> SERVING <br /> James Culbertson, Pres <br /> Patricia E Vannuccl, Secy City of Lodi <br /> Anthonelle Van Spronson <br /> 1601 East Hazelton Avenue, P. O. Box 2009 San Joaquin County <br /> Earl Pimentel Stockton, California 95201 CitIYofly of Manteca amain <br /> Fern Bupbee <br /> Daniel L. Fires 209/466-6781 City of Ripon <br /> John D. Masi, M.D. City of Stockton <br /> 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 /. �/:�5. 1�c ��1,' •�/ �,�Ct �..�� �� <br /> hereby authorize y �-f1r-'� L �,i%rJ� �1 'vr z Scr`L,c�s c-L <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 /> c Ci _ <br /> Owner/Operator: Ti t e: " '` v <br /> Address " <br /> Phone: -3� — ��5� <br /> Date: <br /> _ .�,; <br />