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BOARD OF TRUSTEES <br />James Culbertson, Pres. <br />Mary Anna Love, Vice Pres, <br />Patricia E. Vannucci, Secy. <br />Toinmy Joyce <br />Earl Pimentel <br />Virginia Mathews <br />Daniel L. Flores <br />John D. Mast, M.D. <br />Gene S. Kraham <br />ON JOAQUIN LOCAL HEALTH DISTRICT <br />1601 East Hazelton Avenue, P.O. Box 2009 <br />Stockton, California 95201 <br />(209) 466-6781 <br />Jog! Khanna, M.D., M.P.H., District Health Officer <br />AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br />SITE ASSESSMENT INFORMATION <br />SERVIN( <br />City of Lod <br />San Joaquin Count! <br />San Joaquin Count? <br />City of Escalor <br />City of Manteca <br />City of Ripor <br />City of Stocktor <br />City of Tract <br />San Joaquin Countt <br />I, the undersigned owner and/or operator of the property and/or facility <br />located at a�,� wry juro /61�J <br />hereby authorize �ic��_ �vt ScNcrc� <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/Op <br />Address <br />Date: _ & - :y_ PZ <br />EH 23 041 3/86 <br />EH <br />t1e:� <br />one: -32k-2470' <br />PEI:i�11 i i : ci•`: . <br />