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BOARD OF TRUSTEES SAN 46QUIN LOCAL HEALTH DISTRO SERVING <br /> City of Lodi <br /> James Culbertson,Pres. <br /> Mary Anna Lo ,vice Pres. 1601 East Hazetton Avenue, P.O. Box 2009 San Joaquin County <br /> Love, <br /> San Joaquin County <br /> Patricia E Vannucci,Secy. Escalon <br /> Tammy Joyce Stockton, Califomia 95201 y of <br /> City of Manteca <br /> Earl Pimenlel <br /> Virginia Mathews (209) 466-6781 City of Ripon <br /> City of Stockton <br /> Daniel L Flores <br /> John O.Mast,M.D. Jogi Khanna,M.O.,M.P.H.,District Health Officer City of Tracy <br /> San Joaquin County <br /> Gene S.Kraham <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 / 8// NfrjAall A✓G' . J7�c6c7S b, C/} 9!5'0208 <br /> hereby authorize Wil/ {Zlun{(cQc✓ f/ J��ta7`� <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 �V , �� if3 G'F Phone: (-to 5� yYG -SYyD <br /> Date: <br /> D C <br /> J U N 1 '1987 <br /> ENVIROMENT L HEALTH <br /> PERMIT/SE RVICES <br /> EH 08 05 UGT 13 <br />