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BOARD OF TRUSTEES <br />J.m culb.,! n, Nee. <br />Mary Anna Low, Vic* Prea. <br />Patrtcta E. Vannacaf, Se,,y. <br />Tommy Joyce <br />Earl ►knentaf <br />Vlrpkrla Math*" <br />Oanfot L Floret <br />John O. Most M.D. <br />Gene S. Kraham <br />SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br />1601 East Haxalton Avenue, P.O. Box 2009 City of Lodi <br />San Joaquin County <br />Stockton, California 95201 San Joaquin county <br />City of Eacalon <br />(209) 466-6781 City of Manteca <br />City 04 RIPon <br />Joel Kharwwk M.D, M.►.R, Dkind Room oKker City of Stockton <br />city of Tracy <br />San Joaquin County <br />AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br />SITE ASSESSMENT INFORMATION <br />1, the undersigned owner and/or operator of the property and/or facility <br />located at <br />hereby authorize <br />to release any and all analytical results, geotechnical data and sites <br />assessment information to the San Joaquin Local Ifealth District as soon <br />as it is available and at the same time it is provided to me or my <br />representative. <br />XOwner/operator: �„�yC7 Title: <br />IJ <br />ddre5s35bt�.(/,-'1) <br />xDate. 12-12 <br />EH 08 05 UGT 13 <br />