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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> AI Crow,Pres. San Joaquin County <br /> Earl Pimentel.Vice Pres. 1601 East Hazelton Avenue City of Manteca <br /> Tommy Joyce,Secy. Stockton,California 95205 City of Escaton <br /> James F.Culbertson City of Lodi <br /> John Q Mast M.D. JOGI KHANNA. M.D., M.P.H., DISTRICT HEALTH OFFICER City of Tracy <br /> Virginia Mathews City of Ripon <br /> Thomas Schubert,D.V.M. San Joaquin County <br /> Daphne Slaw City of Stockton <br /> Harvey Williams,PhD. 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 3049 +' a liwry 1.2 Lodi, CA. 95242 <br /> hereby authorize CANOVIE E7TGINEERDIG SERVICES CORP. <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: Owner <br /> Address 3049 i,4H . 12 Phone: (209)369-1132 <br /> Lodi. CA. 95242 <br /> Date: P — I -- <br /> EH 23 041 3/86 <br /> Administration Clinical Services. Environmental Health Public Health Nursing <br /> 468-3404 468-3830 468-3424 469-3860 <br /> Air Pollution Community Services Laboratory Wic <br /> 469-3470 468-3820 468-3460 468.3280 <br />