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g(RD OF TRUSTEES SAN JOAOUIN xLOCAL HEALTH DISTRICT ' ~"--' SERVING <br /> City of Lodi � <br /> James Culbertson,Pres. P.O. BOX 2009 San Joaquin County <br /> Mary Anna Lore,vice Pres. 1601 East Hazelton Avenue, San Joaquin County <br /> Patricia E.Vannucci,Secy. City of Escalon <br /> Tommy Joyce Stockton,California 95201 City of Manteca <br /> Earl a Ma .NNL <br /> el City of Ripon <br /> Virginia Mathews (209) 466-6781 City of Stockton <br /> Daniel L Flores City of Tracy <br /> John D.Mast,M.D. Jogi Khanna,M.D.,M.P.H.,District Health OHtcer 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 QoLr <br /> hereby authorize �5L <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 /> i <br /> Owner/Operator: h T' le: <br /> Address � �5� [, l - hoe:JF <br /> Date: ` d � <br /> l <br /> t <br /> -396C' <br /> 'F <br /> 1- <br /> l <br /> ,y - EH 08 05 UGT 13 <br />