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nonHD of TRUSTEES s '5AN JOAQUIN LOCAL HEALTH DISIRM SLhViN� <br /> Jam«Culbartaon, Praa. city of Lodi <br /> Mwy Awa Love.Vice Pra, 1601 East Hazefton Avenue, P.O. Box 2009 San Joaquin county <br /> Pab,cla E.Vannuccl, aec'y. San Joaquin county <br /> T^ y Joyce Stockton, Calflomla 95201 ply of E*calon <br /> Eart Pknontef city of Manta <br /> vwvin4 MatMwa (209) 466-6781 city of Rli a <br /> Daniel L Elora CMy of Stockton <br /> John D. Mat,M.D. Jogl Khanna,M.D.,M.P.H.,DkWd HoaM Deicer City of Tracy <br /> Dene S.Kraham San Joaquin County <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br />' t I , the undersigned owner and/or operator of the property and/or facility <br /> located at �Ca c'� �L� eyYI13/n1 <br /> hereby authorize CA y6nLc ter« c C-c...P <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 /> Owner/Operator : S ^YidTitle: <br /> Address ��T cif/_ � Phone: <br /> S7oe/e7o�) <br /> Date : <br /> EH 08 05 UGT• 13 <br />