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6,riPD OF TRUSTEES ON JOAOUIN LOCAL HEALTH ARICT SERVING <br /> James Culbertson,Pres. <br /> Mary Anna Love,Vice Pres. 1601 East Hazelton Avenue P.O. Sox 2009 City©t Lodi <br /> Patricia E.Vannuccl,Sec'y. ' San Joaquin County <br /> Tommy Joyce San Joaquin County <br /> Earl Pimentel <br /> Stockton, California 95201 City of Escalon <br /> Virginia Mathews City of Manteca <br /> (209) 466-67$1 <br /> Daniel L.Flores City of Ripon <br /> John D.Mast,M.D. City of Stockton <br /> Jogi Khanna,M.D.,M.F.H.,District Health Officer r;.. City of Tracy <br /> Gene S.Kraham <br /> San Joaquin County <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFO.RMATION <br /> I , the undersigned owner and/or operator of the property and/or facility <br /> located at C'u" /tea �iFaos f o <br /> �t'�,4 <br /> hereby authorize L 13L At 7ZFe �lc.1e3` r17c�7Xi5c Z".n <br /> to release any and all anal ' <br /> tical results ,esults , 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. <br /> Title: <br /> Address /,3 <br /> Phone: -713;21 C" <br /> .77)Al 70 <br /> Date. / <br /> EH 23 041 3/86 <br /> EH <br /> !o3 <br />