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_ a ' <br /> BOARD of TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> Al Crow,Pros. San Joaquin County <br /> Earl Pirnentel,Vice Pres, 1601 East Hazelton Avenue City of Manteca <br /> Tommy Joyce,Secy. Stockton,Califomia 95205 City of frscalon <br /> James F.Culbertson City of Dodi <br /> John 0.Mast.M.D. JOGI KHANNA, M.D., M.P.H, DISTRICT HEALTH OFFICER City of Tracy <br /> Virginia Mathews City of Ripon <br /> Thomas Schubert,D.V.M. San Joaquin County <br /> Daphne Shaw City of Stockton <br /> HafM Williams,Ph.O. San Joaquin County <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 <br /> hereby authorize ���iu� .�i���% /�./iYci� C ,t' <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: J Titlir: - <br /> Address AEI /A/ Phone: �7,7- .Z.Q2Z <br /> Al <br /> Date: 22 -1-6 <br /> F <br /> EH 23 041 3/86 <br /> Administration Clinical Services Environmental Health Public Health Nursing <br /> 468-3410 468-3830 468-3420 468-38M <br /> Air Pollution Community Services Laboratory WC <br /> 468-3470 468-3820 468-3460 468-3280 <br />