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BOARD of TRUSTEES �N JOAQUIN LOCAL HEALTH L TRICT SERVING <br /> James culbertson. Pros. City of Lodi <br /> Palrlcta E. Varinuccl, Sac'y. San Joaquln County <br /> Anthonelte Van Spronsen 1601 East Hazelton Avenue, P. O. Box 2009 <br /> calon <br /> Earl PimCity off maniacs Stockton, Callfornia 95201 City nteca <br /> Fern Bupbee <br /> 209/466781 City of Ripon <br /> Daniel L. Flores <br /> City of Stockton <br /> John D. Mast, M.D. _ <br /> City of Tracy <br /> William J. Wade Jogl Khanna, M.D., M.P.H., 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 (1,I&S 9"0 N AA"C4 10Af2CZ— U ST-0 eKnejI (AL., <br /> hereby authorize J4, 1,-4-1414E +9,4— 4 3S0 V A7-6 S <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 /> TNr cv) r. [-yo t"- C0 r <br /> Owned/Operator: J Title: <br /> Address —Phone: , <br /> SAn1 JdI E GSA, qs-)) Z <br /> Date: SEPT we <br /> U <br /> SEP <br /> ENVlkunnt,�l�� . <br /> FERMITVIHEALTH <br /> 'Ht t AU-SAA t;ON CO. <br /> -SEP 14 1968 <br /> EH 08 05 UGT 13 t 1D <br />