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bOAR0 OF IIILISII.LS <br />James Culbertson. Pres, <br />Pelrlcla I.. Vennuccl. Secy <br />Anlhonalle Van Spronson <br />Lan. Plmnniel <br />Fern oupboe <br />Daniel L. Flores <br />John 0. Maal, M.O. <br />WI111am J. Wade <br />Mary Anna Love <br />SAN JOAQUIN LOCAL HEALTH ()IS 1 IIICT <br />1601 East Hazelton Avenue, P. O, [lox 2(X)9 <br />Stockton, Calliornia 95201 <br />209/466-6781 <br />Jopl Khanna, M.D., M.P.H., Olalrlct Hanflh Officer <br />AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br />SITE ASSESSMENT INFORMATION <br />1, the undersigned owner and/or operator of the property and/or facility <br />located at 0?, 1 d KTE{Z <br />hereby authorize Cq t I F <br />Aiz �q�y t� <br />to release any and all analytical results•e <br />ata <br />assessment information to the San Joaquin LocalHealthlDistrictdasTte soon / <br />as it is available and at the same time it is provided to me or my <br />representative. <br />04ner/Op <br />Address <br />Date: l <br />In OR n5 <br />W AVINII <br />GIIV of I udl <br />San Joaquin Cnunf y <br />City of Escolon <br />city of Manlara <br />City of Ripon <br />City of Stockton <br />City of Tracy <br />San Joaquin y}nunly <br />San Joaquin Cnunly <br />% 0609rc1,CA. <br />