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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> AI Craw,Pres. San Joaquin County <br /> Ead Pimentel,Vlce Pres. 1601 East Hazelton Avenue <br /> City of Manteca <br /> Tommy Joyce,Sec'y. Stockton, California 95205 City of Escalon <br /> James F.CulUerlson City of Lodi <br /> John D.Mast,M.D. JOGI KHANNA, M.D., M.P.H., DISTRICT HEALTH OFFICER City of Tracy <br /> Virginia Mathews City of Ripon <br /> Thomas Schubert,D.V.M. San Joaquin County <br /> Daphne Shaw City of Stockton <br /> Harvey Williams,Ph.D. San Joaquin County <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS , GEOTECIINICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> Y , the undersigned owner and/or operator of the property and/or facility <br /> 1 ac at e d at - I Z 2 o <br /> hereby authorize 0_QC , T71J. <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: co Title: rLorvl 01 AN <br /> Address 2� Phone: Q09 9-Ii � <br /> � a <br /> Date: b <br /> EH 23 041 3/66 <br /> Administration Clinical Services Environmental Health Public Health Nursing <br /> 468-34{)0 468-3830 468-3420 468-3860 <br /> Air Pollution Community Services Laboratory WIC <br /> 46,3-3470 468-3820 468-3460 468-3280 <br />