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• d� 1. i <br /> +sOIARD OF TRUSTEES <br /> U <br /> .ttrr1e, eult,erl,on. Pr . SAN JOAQUIN LOCAL'HEALTH DISTRICT <br /> Patricia E. VannuCcl,' Suc•y SERVING <br /> Anitlonelle Van Spronson !; Clty of Lodi <br /> 1601 East Hiuelton A , P. O. Box 2009 <br /> Earl:Plmenle! venue� � 'Rn Joaquin CUunly <br /> Tarn Bugbee SlOcklon, California 95201 Clly of Eacalan <br /> Oanlel L. Flores Clty of Manteca <br /> Johro•D. Mast, M.o. 209/466-6781 City of Ripon <br /> Wlfllam J. Wade Clty of Slocklon <br /> JoQI Khanna <br /> Mary'sAnna Lore M•D•• M•P•fi., Dialrfcl Health'Offfcar City of Tracy <br /> San Joaquin County <br /> San Joaquin County <br /> E� <br /> AUG 2 0 1�ldb <br /> I . <br /> AUTHORIZATION TO RELEASE` ANALYTICALRESULTSENVIROMENIALLTHGEOTECNNICA�' tM1WlC S, <br /> SITEASSESSMENT INFORMATION <br /> the undersigned owner an <br /> I; d/or taPerator of the property 'and/or -facility <br /> located' atVn i <br /> hereby authorize Ci a fl< E' <br /> 2i SNC_ <br /> to] release any and all analytical resu]ts J <br /> �. geotechnical data and site <br /> assessment information to the San Joaquin Local Health District as soon <br /> J:I <br /> as Eit is available an'd at the same time it iFSE provided to me or my <br /> representative. <br /> Owned/Q� �f`s <br /> Title: <br /> Address <br /> ii Phone: E;�3S— , p <br /> Date: �— <br /> i01 <br /> I <br /> Ei <br /> t <br /> k . <br /> EF <br /> 4 <br /> EH 08$105 UGT 13 --! <br /> Ir <br />