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ti,oaliGor tRustlEs <br />Jemea culuenson, Pres. <br />Palrkla E. Vannuccl, Secy. <br />Anihonalle Van Spronsen <br />Earl Plmentel <br />Fern Gupbee <br />Daniel L. Flores <br />John D. Most, M.D. <br />William J. Wade <br />Mary Anna Lore <br />SAt,JOAQUIN LOCAL HEALTH DISIIIICT <br />1601 East Hazelton Avenue, P. O. Boz 2009 <br />Stockton, California 95201 <br />209/466-6781 <br />Jopl Khanna, M.D., M.P.M., District Health Officer <br />AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br />SITE ASSESSMENT INFORMATION <br />SERVING <br />CII y of Lodi <br />San Joaquin County <br />City of Escalon <br />City of Manteca <br />City of Ripon <br />City of Stockton <br />City of Tracy <br />San Joaquin County <br />San Joaquin County <br />I. the undersigned owner and/or operator of the property and/or facility <br />located at 'LL Al,�[fr�uTtR (>ACurs <br />hereby authorize �y/JM►t (ABort gYak� /Av,- NP A/err7A/ 0i ecAlc�F <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 />A� rM C,4L Gc4/sr . 'J/C'i <br />Ownef/Operator: L SAG NFR ,T,P Title: T> <br />Address Arid ,t/ A(U,`rry Phone:�f'aq �,XGF3G <br />Date: <br />111 <br />08 0', 111,1 13 <br />