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BOARD OF.TRUSTEES SAISOAOUIN LOCAL HEALTH DISAT SERVING <br /> Jaenw.Cuibmbo%Pros, CWY of Lodi <br /> Mary Ams L m vice Pm& 1601 EjW Hazeflon Avetnue, P.O.Box 2009 San 0,-4A CAKwriy <br /> Patricia L VaMwcci.Secy. San Joaq"iw CA" <br /> Tommy form skwj mle cafttr a 95201 <br /> Earl ftn».d.i ab ty of M ma"fe <br /> Vk9k+Ia Ma wwo (209) 466-6781 of PAPa <br /> c <br /> Darwd L.floras <br /> John D.Masi M.D. Joel Khanna,M.D�M.P,H,District HtaM 011ictr city of Sbckbn <br /> Wil'of Tracy <br /> Gent S.Kraham San Joaquin Cwinry <br /> AUTHORIZATION TO RELEASE ANALYTICAL R€SULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> I . 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 site <br /> assessment information to the San Joaquin Local Health District as soon r <br /> as it has been reviewed by PG&E. <br /> Owner/Operator: ' Title: 'J <br /> 6y dz_ <br /> A�,drress �,c 'r1� Phone: •���5 c <br /> Date: <br /> EH 08 05 UGT 13 <br />