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BOARD OF TRUSTEES <br />James lulbertson, Pres. <br />Palrlcla E. Vannuccl, S8C*y. <br />Anihonetle Van Spronsen <br />Earl Plmenlel <br />Fain Dupbee <br />Daniel L. Flores <br />John D. Mast, M.D. <br />William J. Wade <br />Mary Anne Love <br />4 JOAQUIN LOCAL HEALTH DIIkICT <br />SERviNo <br />of L <br />1601 East Hazelton Avenue, P. O. Box 2009 San Joaqlln Cewnldyl <br />u <br />Slocklon, Callfornia 95201 City of Escalon <br />City of Manteca <br />209/466-8781 City of Ripon <br />City of Stockton <br />Jopl Khanna, M.D., M.P.M., District Health Officer City of Tracy <br />San Joaquin County <br />San Joaquln 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 _/dd0/ —7�fffl�GTlf� <br />hereby authorize S _ <br />to release any and all analytical results, geotechnical data and site <br />dssessment 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. _ e <br />Owned <br />Addres <br />Date: <br />EH 08 05 UGT 13 r <br />e <br />. -rosy <br />