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BOARD OF TRUSTEES SAROAQUIN LOCAL HEALTH DISTRA SERVING <br /> James Culbertson,Pres. City of Lodi <br /> Mary Anna Love,Vice Pres. 1601 East Hazelton Avenue, P.O. Box 2009 San Joaquin County <br /> Patricia E.Vannucci,Sec'y. San Joaquin County <br /> Tommy Joyce Stockton, California 95201 City of Escalon <br /> Earl Pimentel City of Manteca <br /> Virginia Mathews (209) 466-6781 City of Ripon <br /> Daniel L.Flores City of Stockton <br /> John D.Mast,M.D. Jog! Khanna,M.D.,M.P.H.,District Health Officer City of Tracy <br /> Gene S.Kraham 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 3030 5 , (t! y 9 9 <br /> hereby authorize stT f C C oil <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: A;Xp Title:. <br /> Address �3rJ S. /�fuV / Phone: ( `i^ d -//>0� <br /> 54�cKh �� 4s�aosl <br /> Date: <br /> EH 08 05 UGT 13 <br />