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1 ,OAND OF TRUSTEES •S JOAQUIN LOCAL HEALTH DIS 1 HICT SERVING <br /> .maa Culbertson,Pres. City of Lodi <br /> iury Anna Low,Vice Pres. 1601 East Hazodon Avenus, P.O. Box 2009 San Joaquin count, <br /> ■trlcte E.Vanaucel,See'y. $an Joaquin county <br /> oay Jaye* Stockton,CaRfofnla 95201 City of EwAlo <br /> m <br /> all Punanlal city of Manteca <br /> idrpfnla Mane" (209)466-6781 Cit,of Ripon <br /> antel L Rom Cay of alocidon <br /> ohn D.Mat.M.D. J90 Khanna,M.D.,M.P.H.,DlaYkf Ness OMcar Cay of Tracy <br /> .ana S.Krahm am Joaquin Calany <br /> i <br /> 1 <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> iSITE ASSESSMENT INFORMATION <br /> iI , the undersigned owner and/or operator of the property and/or facility <br /> located at 1033 East Scotts Avenue Stockton California <br /> ihereby authorize Chemical Research Laboratories * <br /> to release any and all analytical results , geotechnical data and site <br /> iassessment 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 /> irepresentative . <br /> i Owner/Oper r: Title: <br /> Address Phone: <br /> Date: —_//—/ /7_ <br /> * CHEM <br /> ICAL RESEARCH LABORATORIES <br /> i S <br /> 2325 Skyway Drive, Suite K <br /> Santa Maria, California 93445 <br /> i Contact person: <br /> Mike Frantz <br /> (805) 922-2776 <br /> 1 <br /> 1 <br /> i <br /> EH 08 05 UGT 13 <br /> 1 <br />