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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> City of Lodi <br /> James Culbertson, Pres, San Joaquin Count <br /> Mary Anna Love, vice Pres. 1601 East Hazelton Avenue, P.O. Box 2009 San Joaquin County <br /> Patricia E Vannucci, Secy. City of Escalon <br /> Tommy Joyce Stockton, Califomia 95201 City of Manteca <br /> Earl Pimentel (209) 466-6781 City of Ripon <br /> Virginia Mathews City of Stockton <br /> Daniel L Flores City of Tracy <br /> John O. Mast, M.D. Jogt Khs:a;:a, M.D., M.P.H., District Health Officer <br /> _ San Joaquin County <br /> Gene S. Kraham <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 <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 /> u <br /> Owner/Operator: Title : <br /> Address Phone : <br /> Date : <br /> i <br /> f <br /> c <br /> s <br /> EH 08 05 UGT 13 <br />