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BOARD OF TRUSTEES <br />James Culbertson, Pres. <br />Mary Anna Love, Vice Pres. <br />Patricia E. Vannucci, Secy. <br />Tommy Joyce <br />Earl Pimentel <br />Virginia Mathews <br />Daniel L. Flores <br />John D. Mast, M.D. <br />Gene S. Kraham <br />SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br />City of Lodi <br />1601 East Hazelton Avenue, P.O. Box 2009 <br />San Joaquin County <br />San Joaquin County <br />Stockton, California 95201 <br />City of Escalon <br />City of Manteca <br />(209) 466-6781 <br />City of Ripon <br />City of Stockton <br />Jogl Khanna, M.D., M.P.H., District Health Officer <br />City of Tracy <br />San Joaquin County <br />AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br />SITE ASSESSMENT INFORMATION <br />1, the undersigned owner and/or operator of the property and/or facility <br />located at . At. <br />hereby authorize <br />U <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: �S�b�Pl(Z Title: (^LaS1r�21�. <br />Address 110 f!�2o..rdL Phone: <br />tNuo ti ) r -k 9� f <br />Date: °k/A /Z:] <br />Elf 08 05 UGT 13 <br />