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BOARD aF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> James Culhertson, Pres. City of Lodi <br /> Patricia E. Vannuccl, Secy. 1601 East Hazelton AVB ue, P. O. Box 2009 San Joaquin County <br /> Anthonette Van Sproneen City of Escalon <br /> Earl Pimentei Stockton, Calif rnia 95201 City of Manteca <br /> Fern Bugbee 209/466-6781 City of Rlpon <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 /> 64- <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND / sem'` <br /> SITE ASSESSMENT INFORMATION l' <br /> I, the undersigned owner and/or operator of the property and/or facility. <br /> located at 941 East Yosemite Avenue <br /> hereby authorize Applied Geos stems <br /> to release any and all analytical results, g otechnical data and site <br /> assessment information to the San Joaquin Lo(al Health District as soon <br /> as it is available and at the same time it i provided to me or my <br /> representative. <br /> Owner/Op ATitle: <br /> Address Phone: g-os) an– QCI�� <br /> Date: <br /> i <br /> EH 08 05 <br />