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Coes �Um '►aie <br /> u-u-µ1 <br /> F OF TRUSTEES 5Ak1 JOAQUIN LOCAL HEALTH DISTRICT SEERV�ING <br /> ulbertson,Pres. Clty of Lodi <br /> yna Love,Vice Pres. 1601 East Hazelton Avenue, P.O. Box 2009 } SA Joaquln County <br /> Patrlcla E.Vannucci,Secy. I: $ Joaquin County <br /> Tommy Joyce Stockton, Callfornia 95201 .,; City of Escalon <br /> Earl Plmentel , - City of Manteca <br /> Virginia Mathews (209) 466-6781 City of Ripon <br /> Daniel L.Flores City of Stockton <br /> John D.Mask M.D. Jogl Khanna,M.D.,M.P.H.,District Health OfficerCity of Tracy <br /> Gene S.Kraham ,.(A1- H P�dTT�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 Est �IC 1/Erq ,- 7 .) )ti <br /> hereby authorize �A , i 7tw 7 l'!r <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: /' I Title: <br /> Address , b Phone: <br /> Date : <br /> f <br /> EH 08 05 UGT 13 <br />