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. ulbertson, Pres. <br />Ana Love, Vice Pres. <br />,e E. Vannuccl, Sec'y. <br />ny Joyce <br />Pimenlel <br />rginla Mathews <br />/aniel L. Flores <br />John D. Mast, M.D. <br />Gene S. Kraham <br />�• JUAUUIN LOCAL HEALTH DIS1 MCT <br />1601 East Hazelton Avenue, P.O. Boz 2009 <br />Stockton, California 95201 <br />(209) 466-6781 <br />Jogi Khanna, M.O., M.P.H., District Health Officer ._ c r, <br />AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br />SITE ASSESSMENT INFORMATION <br />SEHVIN <br />City of Lo <br />San Joaquin Court <br />San Joaquin Coun <br />City of Escak <br />City of Mante< <br />City of Ripc <br />City of Stocktc <br />City of Trac <br />San Joaquin Count <br />I, the undersigned owner and/or operat� of the property and/or facility <br />located at ,Javc, IJL+— >�.?rl.�l1 //„i, .l ,— i Or- -� -_ <br />hereby authorizeC—c—i Vic— S c.v4l,c �'/ CSL it= L rc L_ (,A�,-- <br />to release any and all analytical results, geotechnical data and site <br />assessment information to the San Joaquin Local flealth District as soon <br />as it is available and at the same time it is provided to me or my <br />representative. <br />Owner/Op <br />Address <br />Date: Z() - ;2y' 'fy <br />Eli 23 041 3/86 <br />Ell <br />itle: ri <br />hone: 3Zy-7 �c7 <br />