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BOARD OF IRUSIEES <br />James CulUenfon. Pref. <br />Patricia E. VannuCCI. Secy <br />Anihonelle Van Sp(onfen <br />Earl Pimentel <br />Fern BugUee <br />Daniel L. Flores <br />John D. Mast. M.D. <br />William J. Wada <br />Mary Anna Lova <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />SERVING <br />City of Lodi <br />1601 East Hazellon Avenue, P. O. Box 2009 <br />San Joaquin County <br />Stockton, California 95201 <br />City of Escalon <br />City of Manteca <br />209/466-6761 <br />City of Ripon <br />City of Stockton <br />JoDI Khanna, M.D., M.P.H., District Health Officer <br />City of Tracy <br />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 j /S i G c -K rGrIi y 2— A:�'i /)O -/ <br />hereby authorize C'4 Y, , , , /�k- —A, �&Of <br />to release any and all analVytical 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/0 <br />Address <br />Aerator: �, ✓ Title: <br />moo. �3ox -72 7 ;;A< <br />Oate: // /9—& <br />Eli 08 05 UGT 13 <br />