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BOA70 OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> James Culbertson,Pres. City of Lodi <br /> Maly Anna Love,Vice Pres. 1601 East Hazelton Avenue, P.O. BOX 2009 San Joaquin County <br /> Patricia E.Vannuccl,Secy. San Joaquin County <br /> Tommy Jgyce Stockton, California 95201 city of Escalon <br /> Earl Pimentei City of Manteca <br /> Virdriia Mathews (209) 466.6781 City of Ripon <br /> Daniel L Flores City of Stockton <br /> John D.Mast,M.D. Jogl Khanna,M.D.,M.P.H.,District Health Officer City of Tracy <br /> Gene S.Kraham 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 LJMTCO-1J -. 33, 0LZ-r(,S aL,I,P, cdA <br /> hereby authorize 2M — J'T/aTCQko LlSC�� JJ CIoU, <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 y <br /> representative. (� <br /> \ f r J^�rv � I . Title: MOwner/Operatoryatlas <br /> Address P.O . `o <br /> 1gaX � e Phone: <br /> Fre..S i t c a• CAI1'f, 9 3 71 S"— <br /> Date: 1 Z — 1 5 — 97 <br /> EH 08 05 UGT 13 <br />