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0 <br />BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br />Jamaa Culbwla . P,ae. City of Lod] <br />Mary Anna Low, Vke Pfee. 1601 East Hazellon Avenue, P.O. foil 2009 san Jooqufn county <br />PaWcla E. vannuccl, sec'y. San Joaquin County <br />Tw y Joyce Stockton, California 95201 City of Eecalon <br />Earl Pknenlal City of Manteca <br />Vk91042 Mathews (209) 466.6781 City of Ripen <br />DenW L Florae city of stoddon <br />John 0. Moat, M.O. Jog! Khania, M.D, M.P.N, DkMd Health fMcw city of Tracy <br />Ogino S. Kroham son Joaquin County <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 <br />hereby auth <br />to release any and all analytical results, geotechnical data and sites <br />assessment information to the San Joaquin Local Ifealth District as soon <br />as it is available and at the same time it is provided to me or my <br />representative. <br />Owner/Op <br />Address <br />era//t��or: Tit1e:0jtn, GJ� <br />Phone: �/(o—I-lq(R'z <br />Date: A <br />I <br />II <br />