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20ARDOF IRVSTEES <br />''amss Culbertson. Pr.,. <br />Patricia E. Vannucci. Sac -y. <br />Anlhonetle Van Spronsen <br />East ►imenlel <br />Fern Sugbee <br />oanlal L Floras <br />John 0. Mast. M.O. <br />William J. Wade <br />Mary Anne Low <br />�.1 <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1601 East Hazelton Avenue. P. O. Box 2009 <br />Stockton. California 95201 <br />209/466-6781 <br />Jogl Khanna. M.D., M.P.H., District Health Officer <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�j�7� �- <br />v �' gSZ S-3 <br />hereby authorize ,,,fA QU $ox /117Z� <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 />SERVING <br />C1ty of Lodi <br />San Joaquin County <br />City of Escalon <br />City Of Manteca <br />City of Ripon <br />City of Sboc4lon <br />City of Tracy <br />San Joaquin County <br />San Joaquin County <br />Owner/Operajor," -,,_' Title: <br />Address /�/G/ �� G c s <br />iuc 57 h 7- <br />-5-/ Z! Phone: ( 6V s.-Y�- 6S�r <br />O <br />Date: <br />0 <br />8 OS UGT 13 <br />