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BOARD C' TRUSTEES <br />James Culbertson, Pres <br />Mary Anna Low. Vice Pra. <br />Patricia E Vannuccl, Secy. <br />Tommy Joyce <br />Earl Pimenw <br />Wglnia Mathews <br />Daniel L Flores <br />John D. Mast, M.D. <br />Gene S. Kraham <br />SAN JOAOLHN LOCAL HEALTH DISTRICT <br />1601 East Hazelton Avenue, P.O. Box 2009 <br />Stockton, Calltomia 95201 <br />(209)466-6781 <br />Jogi Khanna, M.O., WPM- Disfrfcl Health Othcer <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 Eacalon <br />City d 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 property and/or facility <br />located at 7- <br />hereby authorize L <br />to release any and all an lytical results, geotechnical data and site <br />dssessment 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: Title: �1crY�r� <br />Address7 63 S Phone:/� 9� <br />Date: <br />EH 08 05 06T 13 <br />