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BOARD OF TRUSTEES SAirJOAOUIN LOCAL HEALTH DISTRICT SERVING <br /> Jamas Culbanaon,Praa. Cllr a loll <br /> Mary Anna Lew,vim r.... 1601 Ead Hazefton Avenue, P.O.Bok 2009 San,latt W"County <br /> Pahkla E Vannuccl,Sally. Sam Je"uM County <br /> Tommy Joyce Stockton, GlMomla 95201 qty a EWA"" <br /> Fid Phnantel CRY of Manteca <br /> Vlrolnla Mathews (209) 466-6781 qty a Ripen <br /> Danlal L Flora <br /> John D.Meal M.D. Joel Khanna,M.O.,M.P.H.District Naaltlt OMoar CRY of Stockton <br /> Dana S.Knham CRY of Thley <br /> San,lo"uln County <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 _Soo 1 1, , P.!, ! I JAM f� NOl 1 fJQ 1 s'Cac�l�TotJ <br /> hereby authorize IT/,• E I�IV'-!J��IEtITAL Gp�SyI�y�NTS <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: <br /> ,,��IiI�E� <br /> Address _ Q(_ • 9Y`✓ I?'r��'• Phone: 9I(P1B1o4co <br /> Date: <br /> Elf 08 03 UGT 13 <br />