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1 <br /> 8CARD OF TRUSTEES �JOAQUIN LOCAL HEALTH DiICT � ' SERVING <br /> James Culbertson, Pres. � U City of Lodi <br /> Patricia E. Vannucci, Sec'y. � San Joaquin County <br /> Anthonette Van Spronsen 1601 East Hazelton Avenue, P. 0. Box 2009� � City of Escalon <br /> Earl Plmentel Stockton, California 95201 _ �� City of Manteca <br /> Fern Sugbea 209/466-8781 \ "',N City of Ripon <br /> Daniel L. Flores ` ✓�;, City of Stockton <br /> John D. Mast, M.D. City cf Tracy <br /> William J. Wade Jogi Khanna, M.D., M.P.H., District Health Officer ���'pL�`' San Joaquin County <br /> Mary Anna Love � �"�a�,,, -� <br /> San Joaquin County <br /> 1 [" <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 1665 Pacific Avenue, Stockton, California <br /> hereby authorize Applied GeoSystems <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: 51Vyt0VyMEVTAL EAGtA)=L=-R <br /> Address �Pl S L T Phone; U15-q�15-7�7� <br /> AL T CPE <br /> Date: 1l — ag-- SS <br /> ii <br /> EH 08 05 <br />