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BOAR <br /> James <br /> ul yRUS. PfS SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> lams• Culbenaon, tares, St:gyika <br /> 18lilcla E. Vannuccl• Secy Clty of Lodl <br /> 1honalte Van Spronsen 1601 East Hazelton Avenue, P. O. Box 2009 San Joaquin County <br /> Earl Plmentel <br /> FernSugboupDee Stockton, California 95201 City of Escalon <br /> Clly of Manteca <br /> Daniel Flores 209/466-6781 Clly of Ripon <br /> John I7.. Mast, M.D. City of Stockton <br /> William J. Wade Jopl Khanna, M.D., M.P.H.. District Health Officer Cllr of Tracy <br /> Mary Anna Love San Joaquin County <br /> San Joaquln 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 pp , ' <br /> hereby authorize din16 3523�� <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 /> Owner/Operator: Title: Pll� <br /> Address Phone, <br /> 4 • <br /> Date: 1'1 ��q •�Co <br /> s <br /> 414_. nq nr, J ,T-_ 11 _. <br />