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BOARD OF TRUSTEES <br />Ja , Cuborbew. hes. <br />Mary Awry Lem ria hes <br />►abk4 ! Vawrwock Sac'y. <br />Tom" J" <br />Eaa ►Ywerrbl <br />Daniel L Flores <br />Jim D. Mast, M.O. <br />Gene i KraAsm <br />Ste. JOAOUIN LOCAL HEALTH DIS,—AICT <br />1601 Eae1 H&xohon Avenue, P.O. Box 2009 <br />Stockton. CaNlomla 952o1 <br />(209) 166-6781 <br />Jogl KAanr.1 M.D- M.►JI_ Dbbi" Heawh onicar <br />AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br />SITE ASSESSMENT INFORMATION Foie A(7aEs <br />SERVING <br />city of L" <br />Saw Joaquin Co" <br />Saw Joaquin County <br />Cay e1 tocalon <br />City M Manloca <br />City of Ripon <br />Cly of Slocalon <br />City N Tracy <br />San Joaquin Count' <br />1, the undersigned owner and/or operator of the property and/or facility <br />located at <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 has been reviewed by PG&E. <br />Owner/Operator/ Z—Title: <br />Aldress �d 4 r <br />Date: <br />EH 08 05 UGT 13 <br />