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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> Jamas Culbertson,Pres. City of Lodi <br /> Mary Anna Love,Vita Pres. 1601 East Hazetton Avenue, P.O. Box 2009 � San Joaquin County <br /> Patricia E.Vannuccl,Secy. San Joaquin County <br /> Tommy Joyce Stockton, California 95201 A�?� City of Escaion <br /> Earl Plmantel \� City of Manteca <br /> Virginia Mathew* (209) 466-6781 O ,O �,�0 City of Ripon <br /> DanW L Fbns f,�1 �j `��'(N City of Stockton <br /> John D.Mast,M.D. Jogl Khanna,M.D.,M.P.H.,District Hearth \ y %4 City of Tracy <br /> Gena S.Kraham �"�5�V4\6E5 San Joaquin County <br /> F <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 i 1 �. � �u, f An . r n n P t lrr � fi <br /> r� � t! <br /> hereby authorize Cr-, i r o rt^ f r, lCZ; y,n I-r, h . <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 /> OwnrfOpi)eratgr: (' - Title : Oi' vuFloUA <br /> v <br /> Addres �, (�. 6r,iO2 Phone : (2crfJ59 !i7C/ <br /> 3� <br /> Date : <br /> This release pertains only to soil samples that will be taken <br /> in the course of Southwest Hide Co. underground fuel storage <br /> tank closure program. No other analytical data is to be released. <br /> EH 08 05 UGT 13 <br />