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BOARD OF TRUSTEES <br />James Culbertson, Pres. <br />Mary Anna Love, Vice Pres. <br />Patricia E. Vannucci, Secy. <br />Tommy Joyce <br />Earl Pimentel <br />Virginia Mathews <br />Daniel L. Flores <br />John D. Mast, M.D. <br />Gene S. Kraham <br />�.. %.i <br />SAN JOAOUIN LOCAL HEALTH DISTRICT <br />1601 East Hazelton Avenue, P.O. Box 2009 <br />Stockton, California 95201 <br />(209)466-6781 <br />Jogi Khanna, M.D., M.P.H., District Health Officer <br />AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, <br />SITE ASSESS"NT INFORMATION <br />ECHNICAL DATA AND <br />SERVING <br />City of Lodi <br />San Joaquin County <br />San Joaquin County <br />City of Escalon <br />City of Manteca <br />City of Ripon <br />City of Stockton <br />City of Tracy <br />San Joaquin County <br />I, the undersign owner INV/or operator of the property and/or facility <br />located at WQ <br />hereby authorize a 144'4 're'j�Ae <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: �b <br />Address <br />Date: <br />SEP21 1977 <br />ENVlkUME!vIAL HLALTH <br />FERMIT/SERVICES <br />EH 08 05 UGT 13 <br />Title: <br />Phone: i�7 Zld� <br />