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4 <br /> SERVING <br />/.,yA�nna <br /> R TRUSTEES SAN JOAOUIN LOCAL HEALTH DISTRICT City of Led! <br /> ertson,Pres. San Joaquin County <br /> Lorre,Vaca Pres 1601 East Hazelton Avenue, PA. Boz 2009 San Joaquin County <br /> Patricia E.Vannucci,Secy. City o! <br /> Escalon <br /> Tammy Joyce Stockton,Gaiifornia 952fl1 City o!Manteca <br /> mentel City t Ripon <br /> Earl Pi <br /> (2fl9} d66-6781 City of Stockton <br /> Virginia Mathews <br /> iel L Flores City o!Tracy <br /> Dan <br /> John D.Mast,M.D. <br /> Jogi Khanna,M_D.,M.P.H_,District Health Officer 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 A/Z V 6_ <br /> hereby authorizes T -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 /> * i <br /> 0wnerlOperator: Title: <br /> Address 313/ /;P2c.ff PT >� Phone: <br /> Date: " <br /> EH 08 OS UGT 13 <br />