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BOARD OF TRUSTEES GAN JOAQUiN LOCAL HEALTH TTRICT <br /> James Culbodson, Pres, SERVING <br /> Mary Anna Lova,Vka Prm. 1601 East Hazelton Avenue, P.O. Box 2009 CRY of Loaf <br /> Patricia E.Vannucel,Sae'y. San Joaquin County <br /> Tommy Jay" Stockton, California 95201 San Joaquin County <br /> Earl Plmantel City of Escalon <br /> Virginia Mom*" City of Manteca <br /> I, <br /> Daniel L Floras (209) 466-6781 City of Ripon <br /> John D.Most,M.D. mCity of Stockton <br /> Jogl Khanna,M.D.,M.P.H.,Dhtrkt Huhcar h Oei <br /> Gana S.Kraham City of Tracy <br /> San Joaquin County <br /> I <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 atZ5_ S . (� /� cIs Z l5 <br /> hereby authorize / ' <br /> L�. r i'.. i Vin. ._ <br /> to release any and all analytical results , geotechnical data and sites <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: X �� V\ev- <br /> Title: <br /> j Address 3 o-vW ti Phone: .Z09 - 4b4- 750$ <br /> S�Jk�r C <br /> Date: `aZ3/8% <br /> EH 08 05 UGT 13 <br />