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r <br /> BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT 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,Secy. San Joaquin County <br /> Tommy Joyce Stockton, California 95201 City of Escalon <br /> Earl Pimentel City of Manteca <br /> Virginia Mathews (209) 466-6781 AM <br /> City of Ripon <br /> Daniel L Flores TI)) City of Stockton <br /> John D.Mast,M.D. Jogi Khanna,M.D.,M.P.H.,District Health Officer �V Jf_''yby� City of Tracy <br /> Gene S.Kraham VZ <br /> (r Joaquin County <br /> ✓'A 2 i 1987 <br /> ENVIR0 <br /> �PQM T/SERV%�CTy <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 2LG f -o <br /> hereby authorize 2a 2— ? � <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 /> Owne'r/Operator: Q � Title: <br /> Address /�' pp//, hone: <br /> Date: z ° <br /> EH 08 OS UGT 13 <br />