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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> Al Crow,Pres. SERVING <br /> Earl Pimentei,vice Pres. 1601 East Hazelton Avenue San Joaquin County <br /> Tommy Joyce,Secy. Stockton, California 95205 City of Manteca <br /> James F.Culbertson City of Escalon <br /> John D,Mast,M.D. JOGI KHANNA, M.D., M.P.H., DISTRICT HEALTH OFFICER City of Lodi <br /> Virginia Mathews City of Tracy <br /> Thomas Schubert,D.V.M. City of Ripon <br /> Daphne Shaw San Joaquin County <br /> Harvey Williams,Ph.D. City of Stockton <br /> San Joaquin County <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS , GEOTii.11NICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> I , the undersigned owner and/or operator of the property and/or facility <br /> located at 'n y L �-275 <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 /> r <br /> Owner/Operator : f f <br /> Title: �i•• E�(✓'G,e. <br /> Address rG' Phone: r �5 <br /> Date: IL-72- <br /> EH 23 041 3/86 <br /> Administration Clinical Services Environmental Health <br /> 4Public Health Nursing <br /> 68-3400 468-3830 <br /> 469-3420 468-3960 <br /> Air Pollution Community Services Laboratory <br /> 468-3470 468-3820 WIC <br /> 468-34fi0 469-3290 <br /> Alf)c nlnrmal:rin Arn •P— <br />