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" BOARD OF TRUSTEES SAN JOAOUIN LOCAL HEALTH DISTRICT SERVING <br /> Jamas Culbertson,Prat. City of Lodi <br /> Mary Anna Low,Vice Proc 1601 East Hazelton Avenue, P.O. Box 2009 ` Joaquin County <br /> Patricia E.Vannuccl,Soc'y. � Joaquin County <br /> Tommy Joyce Stockton, California 95201D` City N Eacalon <br /> Earl Pknantal 1 City N Manteca <br /> Virginia Mathews (209) 466-6781 City of Ripon <br /> Daniel L Floras ,.,'.l 2 ;) �g.rl City of Stockton <br /> ffk <br /> John D.Mast,M.D. Jogl Khanna,M.D.,M.P.H.,District Health Oar ,,�T i� City N Tracy <br /> Gane S.Kraham ENVIROMENTAi- CEAj1hoaquin County <br /> F ER'dl1/SE <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 4 6tS4 fe/go <br /> hereby authorize Alt nls/V1A t nh Qa&,Vo ep 9(" 30 <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: Title: <br /> Address d Phone : <br /> 80,006, -ti Cnl <br /> Y <br /> Date : 8 — <br /> EH 08 05 UGT 13 <br />