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BOARD OF TRUSTEES <br />James Culbertson, Pres. <br />Mary Anna Love, Vice Pres, <br />Patricia E. Vannuccl, Secy. <br />Tommy Joyce <br />Earl Pimentel <br />Virginia Mathews <br />Daniel L. Flores <br />John D. Mast, M.D. <br />Gene S. Kraham <br />SAPJOAQUIN LOCAL HEALTH DIST•CT SERVING <br />1601 East Hazelton Avenue, P.O. Box 2009 <br />City of Lodi <br />San Joaquin County <br />Stockton, California 95201 <br />San Joaquin County <br />City of Escalon <br />City of Manteca <br />(209) 466-6781 <br />City of Ripon <br />City of Stockton <br />Jogi Khanna, M.D., M.P.H., District Health Officer <br />City of Tracy <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 1340 W. Washington, Stockton, CA 95203 <br />hereby authorize Crisp Tree and Construction Company/Crisp Tank Testing )- <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. r 1 <br />CCLu Cac�Qv/�oQ�uGTJ <br />Owner/Operator: 2 i�-�._ Title:/qi.,_t���p� <br />Address 13�p w (ala Gti �y�n`�� Phone: <br />¢ S,FpU <br />Date:'z� l <br />i <br />EH 08 05 UGT 13 <br />