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' BOARD OF TRUSTEES <br /> SAN JOAOUIN LOCAL HEALTH Jam" SERVING <br /> JunCulbertson,Prea. <br /> Mary Anna Lora,Vic*Pr*a. 1601 East Hazelton Avenue, P.O. Boz 2009 City of Lodi <br /> Patrkta E.vannuccl,sec'y. San Joaquin County <br /> Torr*ny'loyc* Stockton California 95201 San Joaquin county <br /> Earf Pkneni*f ' City of Escalon <br /> Virginia Mathews (209) 166-6781 City of Manteca <br /> Daniel L Flw« City of Ripon <br /> John D.Most.M.D. J091 Khanna,M.D,M.P.H�DkWd Heahh Oitke, City of Stockton <br /> Oen*S.Kraham City of Tracy <br /> San Joaquin County <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECIINICAL DATA AND <br /> SITE ASSESSMENT INFORMATION ,;,( _\;� <br /> I , the undersigned ' ner and/or operator of the <br /> � q property and/or facility <br /> located at <br /> hereby authorize ' <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: / Title: <br /> Address <br /> llate : ? / <br /> a <br /> Ell 08 05 UGT 13 <br />