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S <br />• HOARO OF TRUSTEES <br />Al Crow, Pna <br />luo PLnw,IK VIp PfK <br />Tyr Ja- o Swy. <br />.ruMf F. CWbwLw , <br />Jahn Q LAK M.O. <br />VwOwva WuNwa <br />Dam* Shat QV.LI. <br />H" Www $. PhD. <br />. SAN JOAOUIN LOCAL HEALTH DISTRICT <br />1601 East Hazelton Avenue W counly <br />C. <br />Stocklon. Calltornia 95205 s.n C-ty of AMa <br />CiIY al Maiueca <br />Gry of EWAW <br />JOOI , At.D Y.PJI., DISTRICT HEALTH OFFICER C'h o1 LW, <br />Gry a Tracy <br />Cay a FLpon <br />SanJ"gW Courcy <br />CwV of SIOOLkM <br />Son J"qun County <br />AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br />1 SITE ASSESSMENT INFORMATION <br />I, the undersigned owner and/or operator of the pro or <br />located at S 00 LC gRR p P' Y and/or facility <br />Co a`10 <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 <br />Addre <br />Date: —Of -Go/ . <br />CH 23 041 3/86 <br />y.�nrw�rw <br />400-3400 <br />AM P"uW" <br />466-3470 <br />Ck" SWAC4n <br />468.3a30 <br />CoOwr,uy Swvkss <br />460.3020 <br />EnWwwW-OnW HW,h <br />466-3420 <br />,abos" <br />400.3400 <br />Title:. <br />Phone: <br />Publk H"Ah Hu,W/W <br />460.3060 <br />Wic <br />4W3280 <br />