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r <br />BOARD OF IRUSTLCS <br />James Culbertson, Pres. <br />Patricia E. Vannuccl, Secy <br />Anlhonelle Van Spronson <br />Earl Plmenlel <br />Fern Bupboe <br />Daniel L. Flores <br />John D. Most. M.D. <br />William J. Wade <br />Mary Anna Love <br />.d <br />SAN JOAQUIN LOCAL HEALTH DISTHICT <br />1601 East Hazelton Avenue, P. O. Box 2009 <br />Stockton, California 95201 <br />209/466-6781 <br />Jopl Khanna, M.D., M.P.H., District Health Officer <br />AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br />SITE ASSESSMENT INFORMATION <br />I, the undersigned owner and/or operator of thproperty and/or facility <br />located at ��? j 2G� t1dti� <br />hereby u,124 <br />1 ren rf.'� � to releas y and all analytical results, geotechnical data and site <br />assessmen 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 />SF RVINU <br />Clly of Lodi <br />San Joaquin County <br />City of Escalon <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 />CPrNoHie �b <br />Owner/Operator: ALZ ��- Title: C",a-�L , // <br />Address <br />�'Sff, So Pe Jed Phone: <br />f , <br />Date: <br />EH nR n5 <br />