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0 0 <br /> BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> Crow, Sen Joaquin County <br /> AI Crow,Pres. <br /> Earl ,P tel,vice Pres 1601 East Hazelton Avenue City of Manteca <br /> Tommy Joyce,Secy. Stockton,California 95205 City of Escalon <br /> James F.Culbertson City of Lodi <br /> John D.Mast M.D. JOG[ 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 Shaw oof Stockton <br /> a <br /> J <br /> Harvey Williams,PhD. San Joaquin Count' <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 M o Vv,f3T '�X �TOCKTO l C� . <br /> hereby authorize CLIC (4 ) 1 �-fz l Ays • MQ CKS71J —Ctr� <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 /> OwneriOperator: n IRLI�Mwr� cJ+✓l.ci , Title : <br /> Address 20 Phone: ')09 9 M)L,3 <br /> -5-2,0 3 <br /> c� <br /> Date : <br /> EH 23 041 3/86 <br /> Administration Clinical Services Environmental Health Public Health Nursing <br /> 4683400 468-3830 468-3420 468-3860 <br /> Air Pollution community Services Laboratory WIC <br /> 468-3470 468-3820 468-3460 468-3280 <br />