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' BOARD- of TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT '"�' !SERVING <br /> w <br /> OF <br /> James Culbertson,-Pres. <br /> Mary Anna Love,Vice Pres. City of Lodi <br /> 1601 East Hazelton Avenue, P.O. Box 2009 San J <br /> Patricia E.Vannucci,Secy. San County <br /> Tommy Joyce Stockton, California 95201 San Joaquin Courtly <br /> Earl Pimentel City of Escalon <br /> r <br /> Virginia Mathews � 3 y of Manteca <br /> 209 Cil 466-6781 r�,�• �4 <br /> ,-,�;=-? ,• City of Ripon <br /> Daniel L.Flores t City of Stockton <br /> John D.Mast,M.D. Jogi Khanna,M.D.,M.P.H.,District Health Officer Z-t City of Tracy <br /> Gene S.Kraham �"�� San Joaquin County <br /> E <br /> CFS. H <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 �O/ if"Q <br /> hereby authorize <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: <br /> Title : - <br /> Address Z <br /> K' Phone : C.. <br /> Date: - 26-eg <br /> h <br /> 4 _ <br /> f <br /> i <br /> Eli 08 05 UGT 13 <br /> 5 <br />