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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH`STRICT SERVIN( <br /> James Culbertson,Pres. ISI <br /> Mary Anna Love,Vice Pres, 1601 East Hazelton Avenue P.O. Box 2009 City of Lod <br /> Patricia E.Vannuccl,Sec'y. ' San Joaquin Count <br /> Tommy Joyce Stockton, California 95201 San Joaquin Count <br /> Earl Pimenlel City of Escaloi <br /> Virginia Mathews (209) 466-6781 City of Mantes <br /> Daniel L.Flores City of Ripoi <br /> John D.Mast,M.D. City of Slocktoi <br /> Jogi Khanna,M.D.,M.P.H.,District Health Officer - i`.. City of Trac! <br /> Gene S.Kraham <br /> San Joaquin Caudill <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 -L9gC-) L �O Sterni fc <br /> hereby authorizeac'-( t T7Jv✓Lio- ({2Y <br /> to release any and all analytical results <br /> gcotechnical 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 /> Owner/Operator: GI <br /> Address <br /> Title: <br /> p Q y ���-A <br /> Phone: ? <br /> v2 � <br /> Date: J Ll <br /> EH 23 041 3/86 <br /> Eft <br />