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BOARD OF TRUSTEES <br />At Crow, Pres. <br />Earl Plmentel, Vice Pres. <br />Tommy Joyce, Selly. <br />James F. Culbertson <br />John D. Mas% M.D. <br />Virginia Mathews <br />Thomas Schubert D.V,M. <br />Daphne Shaw <br />Harvey Williams, PhD. <br />0 0 <br />SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br />1601 East Hazelton Avenue <br />sen Joaquin county <br />Stockton, California 95205 <br />city or Manteca <br />Mr Pollution <br />Clry of Escalon <br />JOGI KHANNA, M.D., M.P.H., DISTRICT HEALTH OFFICER <br />City ity of Lodi <br />of Tracy <br />. <br />City of Ripon <br />San Joaquin County <br />City of Stockton <br />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 _ /607> F— '< c ^a J <br />hereby authorize L,94 (,v,qr <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/Op <br />Address <br />Date: <br />EH 23 041 3/86 <br />Administration <br />Environmental Health <br />468-9420 <br />laboratory <br />468.3460 <br />Clinical Services <br />468-9400 <br />468-9830 <br />Mr Pollution <br />Community Services <br />468-3470 <br />468-3820 <br />Public Health Nursing <br />468-9860 <br />WIC <br />468.3280 <br />