Laserfiche WebLink
BOARD OF TRUSTEES <br />tJames Cutbenson, Pres. <br />Pairicle E. Vannuccl, Secy. <br />Anihonette Van Spronsen <br />Earl Pimentel <br />Fern Bupbee <br />Daniel L. Flores <br />John D. Mast, M.O. <br />William J. Wade <br />Mary Anna Love <br />SANJ QUIN LOCAL HEALTH DISTR T SERVING <br />Cfty of Lodi <br />1601 East Hazelton Avenue, P. O. Box 2009 San Joaquin County <br />City of Escalon <br />Stockton, Callfornia 95201 City of Manteca <br />209/466-6781 City of Ripon <br />City of Stockton <br />City of Tracy <br />Jopi Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br />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 <br />hereby auth <br />to release any and all analytical results, geotechnical data and site <br />dssessment 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:���,�L� Ti tl e: <br />Address pcFi /`�J � �%(%Z' Phone������ li Cl, <br />Date: -e% ' <br />a <br />EH 08 05 UGT 13 <br />