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BOARD OF TRUSTEES N JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> dames Culbertson,Pres. <br /> Mary Anna Love,Vice Pres. City of Lodi <br /> 1601 East Hazelton Avenue, P.O. Box 2009 San Joaquin County <br /> Patricia E.Vannuccl,Secy. Sa <br /> Tommy Joyce n Joaquin County <br /> Stockton, California 95201 City of Escalon <br /> Earl Pimenlel <br /> Virginia Mathews (209) 466-6781 City of Manteca <br /> Daniel L.Flores City of Ripon <br /> John D.Mast,M.D. City of Stockton <br /> Jogi Khanna,M.D.,M.P.H.,District Health Officer r City of Tracy <br /> Gene S.Kraham <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 <br /> hereby authorize IL,14 <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: <br /> Title: <br /> Address /yy <br /> Phone: <br /> Date: N <br /> EH 23 041 3/86 <br /> EH <br />