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BOARD OF TRUSTEES M JOAQUIN LOCAL HEALTH G <br /> James Culbertson,Pres, WWO .. -RICT SERVING <br /> Mary Anna Love,vice Pres. 1601 Earl Hazelton Avenue, P.O. City of Lodi <br /> Patricia E.Vannuccl,Secy. Bax 2009 San Joaquin County <br /> Tommy Joyce Stockton, California 95201 San Joaquin County <br /> , <br /> Earl Pimentei City of Escalon <br /> Virginia Mathews (209) 466-6781 City of Manteca <br /> Daniel L.Flores <br /> City al Ripon <br /> John D.Mast,M.D. Jogi Khanna,M.D.,M.P.H.,District Health Officer City of Stockton <br /> Gene S.Kraham r, City of Tracy <br /> San Joaquin 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 <br /> � 1- c •7 <br /> hereby authorize -A4 <br /> -(a f <br /> to release any and all analytical results <br /> 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 /> Address <br /> wner/Operator:Address -" � 1 � q <br /> Title: <br /> Phone: r - <br /> Date: <br /> EH 23 041 3/86 <br /> EH <br />