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BOARD Or IRUSIEES <br />James culU..150n. Pre,. <br />Pelrlcla E. Vannuccl. Sac'y <br />Anthonetle Van Sptoneen <br />Earl Plmentel <br />Fern Bupoee <br />Daniel L. Floras <br />John D. Ma]I, M.D. <br />William J. Wade <br />Mary Anna Love <br />i <br />SAN JOAOUIN LOCAL HEALTH DISTRrCT <br />1601 East Hazelton Avenue, P. O. Box 2019 <br />Stockton, California 95201 <br />209/466-6781 <br />Jopl Khanna, M.O., M,P.N., WaWct Health Officer <br />AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br />SITE ASSESSMENT INFORMATION <br />I, the undersigned owner and/or operatorofthe property <br />and/or facility <br />located at 710�TC'c�7ly— <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 <br />as it is available and at the same time it is provided to me or my <br />representative. <br />OwnJ/Operator: LCL'/'4:;! a �r.�m i IJyt,Ti tle: <br />Address/C� ��7�—� lam, — Phone: <br />Date:f� <br />ORIGINAL <br />jJv a�3�1 <br />EH 08 OS UGT 13 <br />Sf_RVINO <br />Clty of Lodl <br />San Joaquln County <br />City of Eacalon <br />City of Manteca <br />City of Ripon <br />City of Stockton <br />City of Tracy <br />San Joaquin County <br />San Joaquin County <br />