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3OAsD OF TRUSTEES S*JOAQUIN LOCAL HEALTH DISOCT SERVING <br /> James Culbertson,Pres. City of Lodi <br /> Mary Anna Love,vice Pres. 1601 East Hazelton Avenue, P.O. Box 2009 San Joaquin County <br /> 'atricia E.Vannucci,Secy. San Joaquin County <br /> ommy Joyce Stockton, California 95201 City of Escalon <br /> iarl Pimentel City of Manteca <br /> 'irginia Mathews (209) 466-6781 City of Ripon <br /> )aniel L.Flores City of Stockton <br /> ohn D.Mast,M.D. Jogi Khanna,M.D.,M.P.H.,District Health Officer City of Tracy <br /> i'ene 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 435 S . Wilson Way , Stockton , CA 95205 <br /> hereby authorize n!< <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: ��z � 2 Title : <br /> Address d �(/ Phone,;209- �T��31,�- <br /> Date. 2/ " <br /> EH 08 05 UGT 13 <br />