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BOARD OF TRUSTEES *N JOAQUIN LOCAL HEALTH D*RICT SERVING <br /> J;;mes CWIbertson,Pres. City of Lodi <br /> Mary Anna Love,Vice Pres. 1601 East Hazelton Avenue, P.O. Box 2009 San Joaquln County <br /> Patricia E.Vannuccl,Secy. San Joaquin County <br /> Tommy Joyce Stockton, California 95201 City of Escalon <br /> Earl Pimentel City of Manteca <br /> Virginia Mathews (209) 466-6781 City o1 Ripon <br /> Daniel L.Flores City of Stockton <br /> John D.Mast,M.D. Jogi Khanna,M.D.,M.P.H.,District Health Otricer ;�: City of Tracy <br /> Gene. S.Kraham San Joaquin County <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECIINICAL DATA AND <br /> SITE ASSESSMENT INFOILMATION <br /> � I I , the undersigned owner and/or operator of the property and/or facility <br /> located at 330 S. Main Street , Lodi , Ca. 95240 <br /> hereby authorize California ' iter Lab <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 : Zle-AVe o J ii/,, Ti t le: ��✓ <br /> Address .33C> Rhone: c7J Y iJ—,0U <br /> Date. <br /> ( <br /> EI-I 23 041 3/86 JAN 3 1 i9 ? <br /> ENVi%OIVP✓iE,NTAL '-'Eh1.TH <br /> PERMIT/SERVICES <br /> ia[ <br />