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3j <br /> BOARD OF TRUSTEES SA JOAQUIN LOCAL HEALTH DISI iCT SERVING <br /> James Culbertson. Pres. <br /> City of Lodi <br /> Patricia E. Vannuccl, Secy. 1601 East Hazelton Avenue, P. 0. box 2009 San Joaquin County <br /> Anthonstle Van Spronsen City of Escalon } <br /> Earl Pimeniek Stockton, California 95201 City of Manteca <br /> Fern Bugbee !' City of Rlpon <br /> Daniel L. Flores 209/4fifi-fi781 City of Stockton <br /> John D. Mast, M.D. <br /> City at Tracy l <br /> William J. Wade Jogl Khanna, M.D., M.P.H., District Health Officer San Joaquin County F <br /> Mary Anna Love �? San Joaquin County <br /> i <br /> { <br /> 3 <br /> ii <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICALfDATA AND <br /> SITE ASSESSMENT INFORMATION ! <br /> 3; <br /> I, the undersigned owner and/or operator of the property and/or -facility <br /> located at ZIAIC22C�1 <br /> hereby authorize <br /> to release any and all. analytical resUlts, geotechnical data and site <br /> ij . <br /> assessment information to the 'San Joaquin Local Health Diswtrict as soon- <br /> as it is available and at the same time it is provided to:5me or my <br /> i <br /> representative. <br /> Owner/Operator L���� Title: <br /> ii <br /> Address � ..� �Sov� 4 I �.. Phone: ��r�.�'-�� moi'- 2 <br /> Date: <br /> ii <br /> J4 <br /> '1I 1 <br /> i <br /> q <br /> :3 - <br /> :i a <br /> ii <br /> EH 08 05 <br />