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BOARD OF` TRUSTEES S JOAOUIN LOCAL HEALTH DIS CT SERVING <br />Jamas Pro& city of L" <br />Mary Anno Lem We Pias. 1601 East Hazefton Avenue, P.O. Box 2009 San Joaquin County <br />PatriciaE V Secy. San Joaquin County <br />T Stockton, C&Wwnia 95201 CIty of EwAlon <br />Eart CRY of Manloca <br />Virginia mow"" (209) 466-6781 G4 of (upon <br />Daniel L Flores City of Stockton <br />John D. Mad, M.D. Jogs Khanna. M.D.. M.P.H.. Dhtrict HeaM N City of Tracy <br />Gene S. Kraharn San 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 <br />/ 7`; <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 />Owner/Operator: Title: <br />Address Phone: '2 <br />Date: <br />9 <br />EH 08 05 UGT 13 <br />