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)ARD OF TRUSTEES SA.EOAQUIN LOCAL HEALTH DIST SERVING <br /> nes Culbertson,Pres. City of Lodi <br /> ry Anna Love,Vice Pres. 1601 East Hazelton Avenue, P.O. Box 2009 San Joaquin County <br /> ❑icia E.Vannucci,Secy. San Joaquin County <br /> nmy Joyce Stockton, California 95201 City of Escaton <br /> A Pimentel City of Manteca <br /> ginia Mathews (209) 466-6781 City of Ripon <br /> niel L.Flores City of Stockton <br /> in D.Most,M.D. Jogi Khanna, M.D., M.P.H.,District Health Officer City of Tracy <br /> ne S.Kraham San Joaquin County <br /> AUTHORIrZATION 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 : 1\ 8 c r` v o R \-% n <br /> hereby authorize _'M ul,Jct - <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 /> 2 <br /> Owner/O erator = - <br /> P Title: I 't_ U L <br /> Address q GILL Yom; cL is l„a Phone: 9l6 - 9 R 4019 <br /> SAcILAme.�tt-o r ls 9 5 92- 1 - A0 1- <br /> Date: Dov 9 Ig 43 '1 <br /> EH 08 05 UGT la <br />