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BdARII'3F TRUSTEES <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> Jam"Culbedson, Pres. City of Lodi <br /> Mary Anna Lor*,vk•Pr". 1601 East Hazelton Avenue, P.O. Box 2009 San Joaquin County <br /> Patricia E.Vannuccl,Secy. � l \ San Joaquin County <br /> Tommy Joye• Stockton, California 95201 \tit{U\y,\,\ Ctty of Escalon <br /> Fart PlmenlN � City of Manteca <br /> Virginia Mathews (209) 466-6781Y City of Ripon <br /> Daniel L Flor" iv City of Stockton <br /> John D.Meal,M.D. Jogl Khanna,M.D.,M.P.H.,District H"Ith \\+Vv7_ �� C of Tracy <br /> Gone S.Kraham O,V �' 6an Joaquin County <br /> AL H C� <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> I , the undersigned owner and/or operator of the propert and/or facility <br /> located at l�e-r� N- Urv-�„� 554 <br /> hereby authorize 7:1—e0g,� !t hgey& r <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 DSU Cp z Phone: <br /> Date: <br /> EH 08 05 UG'1 13 <br />