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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> James Culben.on,Pres. City of Lodi <br /> Mary:.nna Love,vice Pres. 1601 East Hazelton Avenue, P.O. Box 2009 San Joaquin County <br /> Patricia E.Vannuccl,Secy. San Joaquin County <br /> Tommy Joyce Stockton, California 95201 City of Escalon <br /> Earl Pimenlel City of Manteca <br /> Virginia Mathews (209) 466-6781 City of Ripon <br /> City of Stockton <br /> Daniel L Flores <br /> John D.Mast,M.D. Jogi Khanna,M.D.,M.P.M.,District Health Officer City of Tracy <br /> San Joaquin County <br /> Gene S.Kraham <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 23o n/ , H S—, C2f-V- il= c SZ q <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. <br /> Owner/Operator: /-/ -t4 • Title: <br /> Address 230 We 0 t4 c,(-C/-I S % 1 V 1-�,L OAL 157 S14U Phone: "/S $3 <br /> Date: <br /> EH 08 05 UGT 13 <br />