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SOARO-OF TRUSTEES <br />James Culbertson. Pres. <br />Patricia E. Vannuccl. Sec*y <br />Anthonette Van Spronsen <br />Earl Pimentel <br />Fern Bugbee <br />Daniel L. Flores <br />John D. Mast, M.D. <br />William J. Wade <br />Mary Anna Love <br />Ll <br />L] <br />1601 East Hazelton Avenue, P. O. Box 2009 <br />Stockton, Callfornia 95201 <br />209/466-6781 <br />Jogl Khanna, M.D., M.P.H., District Health Officer <br />AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br />SITE ASSESSMENT INFORMATION <br />1, the undersigned owner and/or operator of the property and/or facility <br />located at 515 W. 11th, Tracy, CA <br />hereby authorize Canonie Environmental, Stockton, CA <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 />'Ywner/Operator: &)tb)4#'v1 P. 5 '1Z- -A)A� T Ti tl <br />Address /- 0 W lcz_ It- AVZ Phon <br />rA. 4/J-J71� I <br />Date: <br />EH 08 05 UGT 13 <br />SERVING <br />City of Lodi <br />San Joaquln 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 />