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1 <br /> BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> Jam"Culbertson,Pr". City of Lodi <br /> Mary Anna Lora,Vice Pres. 1601 East Hazelton Avenue, P.O. BOX 2009 San Joaquin County <br /> Patricia E.Vannuccl,6ec'y. San Joaquin County <br /> Tommy Joyce Stockton, California 95201 City of Escalon <br /> Earl Pimentd City of Manteca <br /> Virginia Maine" (209) 466-6781 Cay of Ripon <br /> DonIM L Flores City of Stockton <br /> John D.Most,M.D. Jogi Khanna,M.D.,M.P.H.,District Heaah Oltker Cay of Tracy <br /> Gane S.Kraham San Joaquin County <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 _�? ycs f- ( .the r r4AA/ <br /> hereby authorize S C a. <br /> to release any and all analy ical 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: N/Ci� m/ Title: <br /> Address 2- Phone: Z 6 <br /> Date : S-16 - P� <br /> EH 08 05 UGT 13 <br />