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BOARD OF TRUSTEES <br /> James Culbertson,Pres. W JOAQUIN LOCAL HEALTH <br /> Mary Anna Love,Vice pre,. " RICT SEAVlf1 <br /> Patricia E.Vannueri,sec y. 1601 East Hazelton Avenue, P.p, <br /> Tommy Joyce Box 2009 City of Lo <br /> Stockton, California 95201 <br /> Ear[Pimentel San Joaquin Coun <br /> Virginia Mathews San Joaquin Coun <br /> City of Escalo <br /> Daniel L.Flores <br /> (209) 466-6781 City of Mantes <br /> John D.Mast,M.D. City of Ripo <br /> Gene S.Kraham Jogi Khanna,M.D.,M.P.H.,District Health Officer Cify of Stockfo <br /> r. City of Trac <br /> San Joaquin Count <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL <br /> SITE ASSESSMENT INFORMATION DATA AND <br /> k+cr lr the undersigned owner and/or operator of the <br /> located at property and/or facility <br /> hereby authorize <br /> to release any and all analytical results, co <br /> assessment information to the San Joaquin L©calechni al data anti Site <br /> as it is available and at the same h District as <br /> time it is provider! to me or my soon <br /> representative . <br /> Owner/Operator: , , <br /> Address /�,� <br /> , Title: <br /> �? P h on e <br /> Date: <br /> EH 23 041 3/86 <br /> C-) <br /> Elf <br />