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I <br /> LARD OF TRUSTEES SA•AQUIN LOCAL HEALTH DISTRICT SERVING <br /> aures Culbertson,Pres. City of Lodi <br /> Aary Anna Love,Vice Pres. 1601 East Hazelton Avenue, P.O. Box 2009 San Joaquin County <br /> •stricla E.Vannuccl,Sec'y. San Joaquin County <br /> o,nmy Joyce Stockton, California 95201 City of Escaion <br /> .art Plmenlel City of Manteca <br /> 'Mginis Mathews (209)488.8781 City of Ripon <br /> )snlel L Flores City of Stockton <br /> ohn D.Masl,M.D. Joel Khanna,M.D.,M.P.M.,District MeaMh Officer City of Tracy <br /> ;ens S.Krahan San 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 1033 East Scotts Avenue, Stockton California <br /> hereby authorize Chemical Research Laboratories * <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/Operatsr: Title: <br /> Address V Phone: <br /> r <br /> Date: <br /> * CHEMICAL RESEARCH LABORATORIES <br /> 2325 Skyway Drive, Suite K <br /> Santa Maria, California 93445 <br /> Contact person: <br /> Mike Frantz <br /> (805) 922-2776 <br /> EH 08 05 UGT 13 <br />