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130AAD OF TRUSTEES SAN JO <br /> AQUIN LOCAL HEALTH DISTRICT SERVING <br /> . AI Crow,Pres, <br /> Earl Pimentet,Vice Pres. 1601 East Hazelton Avenue San Joaquin County <br /> Tommy Joyce,Secy. Stockton, California 95205 City of Manteca <br /> James F.Culbertson City of Escalon <br /> John D.Mask M.D. JOGI KHANNA, M.D., M.P.H., DISTRICT HEALTH OFFICER City of Lodi <br /> Virginia Mathews City of Tracy <br /> Thomas Schubert,D.V.M. City of Ripon <br /> Daphne Shaw San Joaquin County <br /> Harvey Williams,Ph.D. City of Stockton <br /> D r <br /> San Joaquin County <br /> � U <br /> C L i' 1 €Qa <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> r I , the undersigned owper and/orO of the Proper an /or facility <br /> located at <br /> hereby authorize �p <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 /> Owner/Operator: , <br /> Address Title: <br /> Phone: <br /> r <br /> Date. (�-- <br /> EH 23 041 3/86 <br /> Administration Clinical Services <br /> 468-3400Environmental Health Public Health Nursing <br /> 468-38317 4sg-3a2b 468-3860 <br /> Air Poilution Community services <br /> 468-3470 Laboratory WIC <br /> 4fi8`3820 468-3460 468-3280 <br /> AIDS Information 468-3820 <br />