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BOARD OF 'TRUSTEES <br />Al Crow, Pros. <br />Earl Plmentel. Vice Pres, <br />Tommy Joyce, Secy. <br />James F. Culbertson <br />John D. Mast, M.D. <br />Virginia Mathews <br />Thomas Schubert D.V.M. <br />Daphne Shaw <br />Harvey Williams, Ph.D, <br />it 0 <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1601 East Hazelton Avenue <br />Stockton, California 95205 <br />JOGI KHANNA, M.D., M.P.11., DISTRICT HEALTH OFFICER <br />ENVIRONMENTAL HEALTH DIVISION <br />(209) 468-3420 <br />AUTHOR I Zr -r ION TO RELEASE <br />44- ANALYTICAL RESULTS <br />-x- GEOTECHNICAL DATA <br />40- ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br />SERVING <br />San Joaquin County <br />City of Manteca <br />City of Escalon <br />City of Lodi <br />City of Tracy <br />City of Ripon <br />San Joaquin County <br />City of Stockton <br />San Joaquin County <br />I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br />LOCATED AT <br />HEREBY AUTHORIZE (S1itEE1 ADDRESS) �� 4TS (Cllr) <br />(IABORAIORY or CONSOLIANI) <br />TO RELEASE ANY AND ALL ANALYTICAL RESULTS, GEOTECHNICAL DATA AND/OR <br />ENVIRONMENTAL/SITE ASSESSMENT INFORMATION TO THE SAN JOAQUIN LOCAL HEALTH <br />DISTRICT AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED <br />TO ME OR MY REPRESENTATIVE. <br />BUSINESS NAME: <br />(!f APPLICABLE) <br />OWNER/OPERATOR: - 1�a <br />ADDRESS: <br />(NAILING ADDRESS) <br />(Cllr) ,/- (SIAIE) (IIP) <br />PHONE: <br />DATE: I/,/— <br />EH <br />, — <br />EH 23 041 Revised i/B9 <br />Administration Environmental lieatlh Public Health Nursing <br />468-3420 468.3860 <br />Laboratory wic <br />468-3460 468-3200 , <br />Clinical ServiCO3 <br />468.3400 <br />468-3830 <br />Air Pollution <br />Community Services <br />460-3470 <br />468-3820 <br />