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1100AR6 OF TRUSTEES <br />dunes Culbartaon, Pros. <br />Mary Anna Low, Vice Pins. <br />PaWis E. Vannued, Sally. <br />Tommy Joyce <br />Ead Pknentel <br />VkpkNs Mathews <br />Daniel L Flau <br />John D. Mut, M.D. <br />Gane S. Krsham <br />SAIOOAOUIN LOCAL HEALTH DISTFSF <br />1601 East Hazelton Avenue, P.O. Box 2009 <br />Stockton, California 95201 <br />(209) 466-6781 <br />Joel Khanna, M.D., M.P.H, District Heaah Often <br />AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br />SITE ASSESSMENT INFORMATION <br />SERVING <br />City of Lodi <br />San Joaquin County <br />San Joaquin County <br />City of Eacalon <br />City of Manteca <br />City of Ripon <br />City of Stockton <br />City of Tracy <br />San Joaquin County <br />I, the undersigned owner and/or operator of the property and/or facility <br />located at _ ,.�70/ 3. (,Ilkvj <br />hereby authorize <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. A0_7yir >� <br />Owner/operator: �J' /�= Title: ,��CjW <br />Address /L%Ol%lf i ^/.dT�.�i�' T/J Phone: <br />> 11� <br />Date: _ J� J <br />EI{ 08 05 UGT 13 <br />