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BOARD OF TRUSTEES •AN JOAQUIN LOCAL HEALTH ORICT SERVING <br /> Jamea Culbertson,Pres. City of Lodi <br /> Mary Anna Love,Vice Pres. 1 G01 East Hazellon Avenue, P.O. Box 2009 San Joaquin County <br /> Patricia E.Vannuccl,Secy. San Joaquin County <br /> Tommy Joyce Stockton, California 95201 City of Escalon <br /> Earl Pimento] City of Manteca <br /> Virginia Mathews (209) 466.6701 City of Ripon <br /> Daniel L Flores City of Stockton <br /> John D.Mast,M.D. Jogi Khanna,M.D.,M.P.H.,District Health Officer -:r: City of Tracy <br /> Gene S.Kraham San Joaquin County <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECIINICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> rt I , the undersigned owner and/or oerator of the property and/or facility <br /> located at <br /> hereby authorize <br /> to release any and all analytical results , geotechnical data and site <br /> assessment information to the San Joaquin Local Ilealth District as soon <br /> as it is available and at the same time it is provided to me or my <br /> representative . <br /> 9 Owner/Operator : ' I � ', ,� Title <br /> Address / / �/ / <br /> 4,22 r,,,z, Phone <br /> t <br /> r <br /> Date: <br /> Eli 23 041 3/86 <br /> Elf <br />