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BOARD OF TRUSTEES SAOJOAQUIN LOCAL HEALTH mrtDIS SEAVINi <br /> James Culbertson, Pres. <br /> Mary Anna Lore,Vice Pre. 1601 East Hazelton Avenue, P.O. Box 2009 City o/Lo, <br /> Patricia E.Vannucc4 Secy, San Joaquin Count <br /> Tommy Joyce San Joaquin Count <br /> Fara Pimrnlel <br /> Stockton, California 95201 city of Escalo <br /> Virginia Mathews (209) 466-6781 City of Manteca <br /> Daniel L Flores City of Ripoi <br /> John D.Mast, M.D. Jity of Stocktor <br /> ogi Khanna,M.D.MDM.P.H�Distract Health City of Traci <br /> Gene S. Kraham <br /> San Joaquin County <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS , GEOTECHNICAL DATA AND <br /> Si TE ASSESSMEINT INFOrMATION <br /> I, the undersigned owner and/or operator of the property and/or facility <br /> located at 33FO,q/� ,�j LO b <br /> hereby authorize <br /> &AIAIl <br /> to release any and all analytical results, geotechnical dataand 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 /> Owner/Operator: c C2i Title. <br /> Address <br /> �1'y.LoQ�s 5,-! <br /> —32L 3 <br /> Date: �411— <br /> s <br /> EH 08 05 UGT 13 <br />