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eUAHb of IlivsItts <br />JA -60 Culbartson, Pres, <br />Patricia E. Vannuccl, Sec,. <br />Anlhonelta Van Simonsen <br />Earl Plmenlel <br />Fern 9u000e <br />Daniel L. Flores <br />John D. Mast, M.D. <br />William J. Wade <br />Mary Anna Lova <br />SAa JOAOUIN LOCAL IiEAL1 fi UIS' "iICT <br />New <br />1601 East Hazelton Avenue, P. 0. Box 2009 <br />Stockton, Callfornia 95201 <br />209/466$781 <br />Jool Khanna, M.D.. M.P.H., Dletrlcl Health Officer <br />AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br />SITE ASSESSMENT INFORMATION <br />I, the undersigned owner ,and/or operator of the oronerty and/nr fari l ibv <br />located at <br />hereby auth <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 />Owr4of <br />Address <br />Date:i'� <br />EH 08 05 UGT 13 ___ <br />Title:(",:" <br />Phone: eJ <br />SLRVINO <br />Clly of Lodi <br />San Joaquin County <br />City of Escaton <br />City of Manteca <br />City of Ripon <br />City of Stockton <br />City of Tracy <br />San Joaquin County <br />San Joaquin County <br />