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BOARD OF TRUSTEES WN JOAQUIN LOCAL HEALTH ArRICT SERVINi <br /> James Culbertson, Pres. <br /> Mary Anna Lore, Vice Pres. 1601 East Hazelton Avenue, P.O. Box 2009 City of Loc <br /> Patricia E.Vannucci,Secy. San Joaquin Count- <br /> Tommy Joyce Stockton, California 95201 San Joaquin Count <br /> Earl Pimentel City of Escalo, <br /> Virginia Mathews (209) 466-6781City of MantecE <br /> Daniel L. Flores City of Riper <br /> John D. Mast, M.D,., ,. City of Stockton <br /> Gene S.Kraham <br /> Jogi Khanna,M.D.,M.P.H.,District Health Officer City of Tracy <br /> San Joaquin County <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> _I I , the undersigned owner and/or operator of the property and/or facility <br /> located at L°%,« /s/.� .�� 'f ��vc��ro,rr <br /> hereby authorize <br /> to release any and all analytical results, <br /> te <br /> assessment information to the San Joaquin Local eHealth lDistrict data daslsoon <br /> as it is available and at the same time it is provided to me or my <br /> representative. / <br /> Owner/Operator: <br /> Address <br /> �` Title: <br /> ,Q.-r, � cT <br /> A Phone: '7�/— <br /> 5 <br /> Date: �� ti• /�f7 <br /> EH 23 041 3/86 <br /> EH <br />