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i <br />BOARD OF TRUSTEES <br />James Culbertson, Pres. <br />Patricia E. Vannuccl, Secy <br />Anthonette Van Spronson <br />Earl Pimento[ <br />Fern Bugbee <br />Danlel L. Flores <br />John D. Mast, M.D. <br />William J. Wade <br />Mary Anna Love <br />1* 40 <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1601 East Hazelton Avenue, P. O. Box 2009 <br />Stockton, California 95201 <br />209/466-6781 <br />Jogl Khanna, M.D., M.P.H., District Health Officer <br />SERVING <br />City of Lodi <br />San Joaquin County <br />City of Escalon <br />City of Manleca <br />City of Ripon <br />City of Stockton <br />City of Tracy <br />San Joaquin County <br />San Joaquin County <br />FvR�MFN B Zb <br />rip <br />MPJ, Jq� f! <br />AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND As&/fcl ,, <br />SITE ASSESSMENT INFORMATION 4,9 <br />I, the undersigned owner and/or operator of the property and/or facility <br />located at 204 and 2282 E. Lodi Avenue, Lodi, CA <br />hereby authorize fannnip Engineering_ <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: �.�-_�„ '��� Title: <br />Address 1250 EdgeCvood Drive Phone: 369-3215 <br />Lodi, CA 95240 <br />Date: _-- A _ -id <br />EH 08 05 UGT 13 <br />