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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTICT SERVING <br /> James Culbertson, Pres. City of Lodi <br /> Palrlcta E. Vannuccl, Secy. San Joaquln County <br /> Arithonette Van Spronsen 01 East Hazelton Avenue, P. �, Box 2009 <br /> City of Escalon <br /> 'Earl Pimentel Stockton, Callfornia 95201 City of Manteca <br /> Fern Bugbee 209/466-6781 City of Ripon <br /> Daniel L. Flores City of Stockton <br /> John D. Mast, M-D. City of Tracy <br /> Wltiiarn J. Wade Jogl Khanna, M.D., M,P.H„ Dletrict Health officer San Joaquin County <br /> Man;"Anne Loy@ 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 1301 West Lockeford Street <br /> hereby authorize2r � �, <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 /> Owned/Operator: Title: OXIVAI,6 NG ;f Pe; (i 4e <br /> Address ,/y erg Phone: 333-©q00 <br /> Date: 8&A� <br /> EH 08 05 UGT 13 <br />