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BOARWOF TRUSTEES SAN OAQUIN LOCAL HEALTH DISTRIS SERVING <br /> Jamas CubaAson,Pros. city of Lodi <br /> Mary Anna low,Vko Praa. 1601 East Hazelton Avenue,P.O.Box 2009 San Joaquin County <br /> Pa" L varuwcc4 Soc,y. San Joaquin County <br /> Torg Joys Stockton,Calllomla 95201 COY of Eaeakn <br /> EaA PYrranim - City of Mantau <br /> VkVWa Mattm s (209) 466-6781 Cay of mpon <br /> Da.: L Flores City of St«Mon <br /> John D.Most M.D. Jo91 Khania,M.D,MAH,Dbb'4ci HeafM Otfic« City of Tracy <br /> Gene S. Kraham San Joaquin County <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 150 NO r �,, S G1. un G <br /> hereby authorize _L,yne, - &jeskyn CO Cir I <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: Title: 110,4 If M�/� <br /> aylaj C.c <br /> Address ZE6 NbrAr. Y e— , phone: 4'jojZyj��- Is/ <br /> _!:� {-Vnao h 'GA q <br /> Date: /7 ZIT <br /> EH 08 05 UGT 13 <br />