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1 <br /> BOARD of TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVINa <br /> James Culbertson, Pras. City of Lodi <br /> Patricia E, Vannuccl, Secy. 1601 East Hazelton Avenue, A, a. Box 2009 San Joaquin County <br /> --.Anthonotte Van Spronsen City of Eso-alon <br /> I art Plmontal Stocktrn,California 95201 City of Manteca <br /> Fern augbeo 209/466-6781 City of Ripon <br /> Daniel L. Flores City of Stockton <br /> John D, Mast,M.D. 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 110 WEST SONORA STRUT, STOrKTnM rAI.TFQRN A —.— <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: J Title: '17„eek/,< <br /> Address Phone: g -sk2: <br /> Date: <br /> L. <br /> ka <br /> '.� EH 08 05 <br />