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BOARD OF TRUSTEES <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />SERVING <br />At Crow, Pres. <br />Earl Plmentel, Vice Pres. <br />1601 East Hazelton Avenue <br />San Joaquin County <br />City of Manteca <br />Tommy Joyce. Secy. <br />Stockton, California 95205 <br />City of Escalon <br />James F. Culbertson <br />City of Lodi <br />John D. Mast, M.D. <br />JOGI KHANNA, M.D., M.P.H., DISTRICT HEALTH OFFICER <br />City of Tracy <br />Vlrglnls Mathews <br />City of Ripon <br />Thomas Schubert D.V.M. <br />ENVIRONMENTAL HEALTH DIVISION <br />Sen Joaquin County <br />Daphne Shaw <br />( 2219 ) 468-3420 <br />City of Stockton <br />Harvey Williams, PlaD. <br />San Joaquin County <br />AUTHOR I ZAT I ON TO REI-E:A8E <br />-0+ ANALYTICAL RESULTS <br />4E GEOTECHNICAL DATA <br />4*- ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br />I, THE UNDERSIGNED OWNER AND/OR OPERATOR, OF THE PROPERTY AND/OP. FACILITY <br />LOCATED AT <br />(SIREEI ADDRESS) (Clly) <br />HEREBY AUTHORIZE (GTEL) GROUNDWATER TECHNOLOGY ENVIRONMENTAL LABROTORY <br />(IAADRAIDR7 or CDASDIIARI) <br />TO RELEASE ANY AND ALL ANALYTICAL RESULTS, GEOTECHNICAL DATA AND/OR <br />ENVIRONMENTAL/SITE ASSESSMENT INFORMATION TO THE SAN JOAQUIN LOCAL HEALTH <br />DISTRICT AS SOON AS IT IS AVAILAPLE AND AT THE SAME TIME IT IS PROVIDED <br />TO ME OR MY REPRESENTATIVE, <br />IBUSINESS NAME: <br />IOWNER/OPEP,ATOR: <br />ADDRESS: <br />(If <br />ADDRESS) <br />(City) (SIAIE) (lit) <br />PHONE: (�±B L5oQ <br />DATE: oc)y- I Cf 6q <br />EH 23 0141 Revised 1/89 <br />Administration Clinical Servicos Environmental Health <br />468.3400 468-3830 468-3420 <br />Air Pollution Community Servlces Laboratory <br />468-3470 468-3820 408-3400 <br />AIDS Inlormallon 468-3820 <br />Public Hoalth Nursing <br />463-3860 <br />WIC <br />468.3200 <br />