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BOARD OF TRUSTEES SAN , —AOUIN LOCAL HEALTH DISThi,;T SERVING <br /> James Culbertson, Pres. <br /> Pairlcle E. Vannuccl, SecCity of Lodiy. San Joaquin Anlhonette Van Spronsen 1601 East Hazelton Avenue, P. O. Box 2009 County <br /> Earl PImentei Stockton, California 95201 City of E3calon <br /> Fern Bupbee City of Manteca <br /> Daniel L. Flores 209/466-6781 City of Ripon <br /> John D. Mast, M.D. City of StocktonCity of Tracy <br /> William J. Wade Jog[ Khanna, M.D., M.P.N., 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 �� ���� s; �T�jL7C�LJ <br /> hereby authorize E'Gl/�Fi��'( L �� /ti c:. <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 /> Owned/Operator: �`lL� �f(� =C,2Title: <br /> Address �U /� C / (oj Phoney/ � lf�/��1U2j <br /> Date. <br /> EH 08 05 UGT 13 <br />