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BOARD OF TRUSTEES <br />James Culbertson, Pres <br />Patricia E. Vannuccl, Secy <br />Anthonette van Spronsen <br />Earl Plmentel <br />Fern Bupuee <br />Daniel L. Flores <br />John D. Mast, M.D. <br />William J. Wade <br />Mary Anna Love <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1601 East Hazelton Avenue, P. O. Box 2009 <br />Stockton, California 95201 <br />209/466-6781 <br />Jopl Khanna, M.D., M.P.H., Dletrict 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 851 E. Lodi Avenue, Lodi, CA <br />hereby authorize Canonie Environmental, Stockton, CA 983-1340 <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: Title: ,IZ� <br />Address �iS- `",-� Phone: <br />Date: 2 - ,F <br />EH 08 05 UGT 13 <br />SERVING <br />City of Lodi <br />San Joaquin County <br />City of Escalon <br />City of Manteca <br />City of Ripon <br />City of Stockton <br />City of Tracy <br />San Joaquin County <br />San Joaquin County <br />