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BOARD OF TRUSTEES <br />James Culbertson, Pre,, <br />Patricia E. Vannuccl, See'y <br />Anthonelle Van Spronsen <br />Earl Plmenlel <br />Fern Duguae <br />Daniel L. Flora, <br />John D. Mast. M.D. <br />William J. Wade <br />Mary Anna Love <br />�I <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />SERVING <br />Citof 1601 East Hazelton Avenue, P. O. Box 2(X19 San Joaquin Count <br />Stockton, California 95201 City of Escalon <br />209/466-6781 City of Manteca <br />City of Ripon <br />city of Stockton <br />Jopl Khanna, M.D., M.P.H., District Health Officer City of Tracy <br />San Joaquin County <br />Sart Joaquin County <br />JAN u <br />ENVIROMENTAL HEALTH <br />FER,10I T /SERVICES <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 TRI VALLEY 9200 E EIGHT MILE RD STOCKTON CA <br />hereby authorize CALIFORNIA WATER LAB <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: _l Title: <br />Address V yr <br />Phone: <br />Date: <br />IN OR nR n5 <br />