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E ,z ARD Of TRUSTEES SAN ,lOAOUIN LOCAL HEALTH DISTRICT <br /> ci—mes Culbertson, Pres, SERYfNQ <br /> PaIrIcla E. Vannucci, Secy- City of Lodl <br /> >' Anthonetle Van Spronaen 1601 East Hazelton Avenue, P O. Box 2009 San Joaquin County <br /> Earl Pimentel StoCkton, Callfornia 95201 City of Escelon <br /> Fern f3uQUea City of Manteca <br /> Daniel Florey 209/466-67'81 City of Ai"pon <br /> John D,. Mail, M.D. City of Stockton <br /> William J. Wade Jog] Khanna, M.D., M.P.H., Diatrlct Health Officer City of Tracy <br /> Mary Anna Love San Joaquin County <br /> 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 <br /> hereby authorize . i <br /> to release any and all anal tical 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 /> • f <br /> Owner/OperatorTitle: )-'14 <br /> Address / Phone: ��' - � <br /> a 5— 6 <br /> Date: <br /> EH 08 05 <br />