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e0AR0 OF TRUSTEES <br />Jadies Culbenson, Pres. <br />Patricia E. Vannuccl, Soc'y. <br />Anthonstte Van Spronsen <br />Earl Plmantel <br />Fern Bupbeu <br />Daniel L. Flores <br />John D. Mast, M.D. <br />William J. Wade <br />Mary Anna Love <br />3AN JOAQUIN LOCAL HEALTH 'STRICT SERVING <br />..r City of Loci <br />1601 East Hazelton Avenue, P. O. Box 2009 San Joaquin County <br />City of Escalon <br />Stockton, California 95201 City of Manteca <br />209/466-6781 City of Ripon <br />City of Stockton <br />City of Tracy <br />Jo01 Khanna, M.D., M.P.H., District Health Officer 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 521 NORTH CHEROKEE LANE LODI, CA 95240 <br />hereby authorize RAMCON 1450'HARBOR BLVD, W. SAC CA 95691 <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. <br />Owner/Oper4tor: � f Ti tl e: (C-1 I { (. L _ <br />Address /_�, a ✓c <Ctr` ,. Phone: <br />Date: <br />I <br />IAN <br />ENVIROMEiVTAL HEALTH <br />FERMIT/SERVICES <br />EH <br />08 <br />05 <br />