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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> James Culbertson,Pres. City of Lodi <br /> Mary Anna Lore,vice Pres. i 601 East Hazelton Avenue, P.O.Sox 2009 San Joaquin County <br /> Patricia E.Vannucci,Secy- San Joaquin County <br /> Tommy Joyce Stockton,California 95201 Cit'of melon <br /> Earl Pimentei City of Manteca <br /> Virginia Mathews (209) 466-6781 City of Ripon <br /> Daniel L Flores City of Stockton <br /> John D.Mast,M.O. Jogi Khanna,M.D.,M.P.H.,District Health Officer City of Tracy <br /> Gene S.Kraham San Joaquin County <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS. GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> I <br /> I. the undersigned owner and/or operator of the property and/or facility <br /> located at /req,od <br /> hereby authorize <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: <br /> Address !Y ?oe w jAwy, Phone: �16"j <br /> 0-4- <br /> -- <br /> Date: /f <br /> r <br /> EH 08 05 UGT 13 <br />