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BOARD OF TRUSTEES <br />James Culbertson, Pres. <br />Mary Anna Love, Vice Pres. <br />Patricia E. Vannucci, Secy. <br />Tommy Joyce <br />Fad Pimentel <br />Virginia Mathews <br />Daniel L Flores <br />John D. Mast, M.D. <br />Gene S. Kraham <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1601 East Hazelton Avenue, P.O. Box 2009 <br />Stockton, California 95201 <br />(209)466-6781 <br />Jogi Khanna, M.D., M.P.H., District Health officer <br />AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br />SITE ASSESSMENT INFORMATION <br />SERVING <br />City of Lodi <br />San Joaquin County <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 />I, the undersigned owner and/or operator of the Droperty and/or facility <br />located at Z �IV4Vy/ �'I <br />1 J <br />hereby authorize <br />to release any and all analytical f4sults, 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 the or my <br />representative. <br />Owner/Operator: <br />Address <br />Date: - `7 <br />EH 08 05 UGT 13 <br />Title: <br />Phone: ZZEL <br />49 <br />