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BOARD OF TRUSTEES IL JOAQUIN LOCAL HEALTH DIIRRICT SERVING <br /> Al Crow,Pres. <br /> •- EarlPlmenlel,Vice Pres 1601 Fast Hazelton Avenue San Joaquin county <br /> Tommy Joyce,Secy. Stockton,California 95205 City of Hamate <br /> James F.Culbertson City of Escalon <br /> John D.Mesh M.D. JOGI KHANNA, M.D., MP.H., DISTRICT HEALTH OFFICER City of Lodi <br /> City of Tracy <br /> Virginia Mathews <br /> Thomas Schubert,D.V.M. City of Ripon <br /> Daphne Shaw San Joaquin County <br /> Harvey Williams,PhD. City of Stockton <br /> Sen Joaquin County <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 S 0 N <br /> hereby authorize <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 Phone��0`�)a Z3 Z33� <br /> Date: <br /> EH 23 091 3/86 <br /> Administration Clinical Services Environmental Health Public Health Nursing <br /> 468-3400 468-3830 468-3420 468-9860 <br /> Air Pollution Community Services Laboratory WC <br /> 468.3470 468-3820 468-3460 <br /> 468.3280 <br />