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BOARD OF TRUSTEES SAI _40AOUIN LOCAL HEALTH DISTRr: T SERVING <br /> James Culbertson,Pree. <br /> Mary,A iru Last ace Print. 1601 East Hazelton Avenue, P.O. Box 2009 City of Lod, <br /> Patricia E.Vannuccl,Secy. San Joaquin County <br /> Tommy Joyce Stockton,California 95201 San Joaquin County <br /> Earl Plmentel City of Eacalon <br /> Virginia Malhewe (209) 466-6781 City of Manteca <br /> Daniel L Florast' p City of Ripon <br /> City of Stockton <br /> John D,Mad,M.D. Jogl Khanna,M.O.,M.P.M.,District Health Omcar - �, <br /> Gene S.KraMm City of Tracy <br /> San 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 ._;'/l /_? G(/ ��'PZ <br /> hereby authorizeXJm2a Waj'-Y LaLs <br /> to release any and all analytical results, gootechnical 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 /> Owner/Operator: /// �✓� ��/� <br /> Address 50 —Title: <br /> _L1 I1, r Phone: �p4 R35 �Q <br /> ?rcrcu�6 <br /> Date: 1 -3-1 P7 <br /> Ell 23 041 3/06 <br /> El , ' <br />