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BOARD OF TRUSTEPS SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> City of Lodi <br /> James Culbertson,Pres. San Joaquin County <br /> Mary Anna Love,Vice Pres. 1601 East Hezetton Avenue, P.O. Box 2009 San Joaquin County <br /> Patricia I-Vannucci,Secy. City of Escalon <br /> Tommy Joyce Stockton,Caldomla 95201 City of Manteca <br /> Fad Pimentel City of Ripon <br /> Virginia Mathews (209) 466-6781 City of Stockton <br /> Daniel L Flores City of Tracy <br /> John D.Mast M.D. Joyl Khanna,M.0„M.P.H.,District Health macer San Joaquin County <br /> Gene S.Kraham .. <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 /"7,Z ((1 (JJZ �c'C-fi - 'ACk)�Ory <br /> hereby authorize /{oJ2tGC <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. 1 <br /> Owner/Operator• fi ow'#'w Title: ;, L'04p".z, <br /> Address / a ) rlJ, l/J Phone: 9 4 �- /-25 <br /> Date: <br /> EH 08 05 UGT 13 <br />