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' BOARD OF TRUSTEES SAOOAQUIN LOCAL HEALTH DISACT SERVING` <br /> James Culbertson, Pres. City of Lodl <br /> Patricia E. Vannuccl, Secy. San Joa <br /> Anthonette Van Spronsen 1601 East-Hazelton Avenue, P. 0. Box 2009 quln County <br /> City of Escelon <br /> Earl Pimentel L. Flougbee Slockton, California 95201 City of Manteca <br /> Fern B $781 City of Rlpon <br /> Daniel L. Flores 209/466 <br /> John D. Mast, 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 `wo!/ �r fl/7?iN Gi e7 , STOZ.ei <br /> hereby authorize <br /> to release any and all analytical results, geotechnical data and site <br /> dssessment 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: <br /> Address �� � `jlp �j Phone: <br /> Date: <br /> EH 08 05 UGT 13 ' <br />