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9BOARD OF TRUSTEES SAJOAOUIN LOCAL HEALTH DIS46CT SERVIN <br /> James Culbertson,Pres. City of Lo <br /> Mary Anna Love,Vice pre,. 1601 East Hazelton Avenue, P.O. Box 2009 San Joaquin Coun <br /> Patricia E Vannucci.Secy. San Joaquin Count <br /> Tommy Joyce Stockton, Califomia 95201 City of Fxalo <br /> Fart Pimentef City of Mantec <br /> Virginia Mathews (209) 466-6781 City of Ripo <br /> Daniel L Flores City of Stockto <br /> John D.Mast, M.D. Jogi Khanna,M.D., M.P.H.,District Health Officer City of Trac <br /> Gene S.Kraham San Joaquin Count <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS , GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> I , the undersigned owner and/or operator of the property and/or facility <br /> located at 33E.0tj Lo cam. <br /> hereby authorize y,f VVI /P v✓h�>vr.¢� <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.Cwnet/Operator: Title: � j Qty <br /> Address � � KPhone: 92-2-3 <br /> O <br /> 9 5/!q— <br /> Date: / _ 4/— d-P <br /> EH 08 05 UGT 13 <br />