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BOARD Or TtiuSTEES SAN JOAOLIIN LOCAL HEALTH DISTRICT SERVING <br /> James Culbertson,Pres. City of Lodi <br /> May Anna Loire,vice Pres. 1601 East Hazetton Avenue, P.O. Box 2009 San Joaquin county <br /> Patricia E.vannucci,Secy. San Joaquin County <br /> Tommy Joyce Stockton,CalNomia 95201 City of Exalon <br /> Earl Pinter" Ctty of Manteca <br /> Viirginio Matt w (209) 466-6781 City of Ripon <br /> Daniel L Flores City of Stockton <br /> John D.MaA M.D. Jogi Khanna,M.D.,M.P.H.,District Health Officer City of Tracy <br /> Gene S. Kraham San Joaquin County <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> I, the u, igned owner and/ operator the propert d/or facility/) / <br /> located at / , /�/ PST—/ /����cc7—� � rt1�'•¢r� <br /> hereby authorize —TA� <br /> to release any <br /> l <br /> Ana 1^c5P're4tis nical data and ite <br /> dssessment information to the San Joaquin Locat ea th 1 trict as soon <br /> as it is available and at the same time it is provided to me or my <br /> representative. <br /> Owner/Operator. �,/� /" Title: <br /> Address /Zz/ ,(/ �,/�E.iG !_ i Phone: <br /> Date: <br /> zy� <br /> EH 08 OS UGT 13 <br />