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(1K1 _ <br /> RD OF TRUSTEES $6 JOA4VIN LOCAL HEA!-7H DISTR <br /> James Culbertson,Prom C1 SERVING <br /> Maly Ann*Love.Vice pres. od <br /> ��a <br /> Patricia E.Vannuccl,S"'y, 1601 l=ast Hazelton Avenue, iP.a. Box 20 9 � �� City of Lodi I <br /> (& Sen Joaquin County <br /> Tommy Joyce 1 San Joaquin County <br /> Earl Pkmsntel Stockton, California 8521 � n , <br /> Virginia Mathews v \�� City of Eicalon <br /> Daniel L,Flores (208) 466-6781 F�ej t„ .\v, City of Manteca <br /> W John D.Most,M.D. ^\-,� G�5 City Alpon <br /> Jogi Khanna,M.D.,M.P.H.,District Health otricer. 1`; '.1��`�v\ <br /> Gene S.Kreham Clty of StocktonCity of Trocy <br /> San Joaquin County <br /> - j <br /> • I <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, : GEOTECHNICAL, DATA <br /> AND <br /> SITE ASSESSMENT ,INFURMATICN <br /> t <br /> I , the undersigned owner and/or operator of the property and/or facility <br /> located at cL <br /> hereby authorize i <br /> to release any and all analytical results , <br /> 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 <br /> representative . is <br /> Provided to me- or my � <br /> I <br /> Owner/Operator : <br /> ci as e:�� QR Cd Title : <br /> Address <br /> Phone: ,Iqq -Old <br /> Lia�►.`eo 1 LA <br /> Date. l /I AM <br /> Eli 23 041 3/86 <br /> E <br /> i <br /> I <br /> y <br />