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BOARD OF TRUSTEES <br />Join CuWaMoo, Pros. <br />4.. Mary Anne taw, Via Pros. <br />►ahkfa E. Vannwc4 $«'y. <br />,n Tommy Joyco <br />Earl Pitnanfaf <br />Virginia Ma1Mwa <br />Dar" L Florae <br />JoM D. Main, M.D. <br />Oatta S. Kraham <br />.AN JOAQUIN LOCAL HEALTH DriRICT <br />1601 East Hazefton Avenue, P.O. Box 2009 <br />Stockton, California 95201 <br />(209) 166-6731 <br />Joel Khanna, MA., M.M DfaMd H"Nh OQt:ar <br />AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br />SITE ASSESSMENT INFORMATION <br />SERVING <br />City or Lodi <br />San Joaquin County <br />San Joaquin County <br />City of Eaoalon <br />City of Maniacs <br />City of Ripon <br />City of Stockton <br />city Of Tracy <br />San Joaquin County <br />I, the undersigned owner and/ot-operator of the property and/or facility <br />located at / al i� �,R} �� fl d .Ga7�h i (a77 <br />�1331� <br />hereby authorize <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/Op <br />Address <br />Date:�'— J/� <br />EH 08 05 UGT 13 <br />itle: <br />hone: j . —,J'1` y <br />