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n. <br /> Unauthorized Release Form Page 2 of 12 I <br /> I <br /> X1. CERTIFICATION <br /> I HEREBY CERTIFY THAT THE INFORMATION REPORTED HEREIN <br /> IS TRUE AND ACCURATE TO THE BEST OF MY,KNOWLEDGE. <br /> XII. REGULATORY USE ONLY <br /> LOCAL AGENCY CASE NUMBER REGIONAL BOARD CASE NUMBER I <br /> 1125 390632 <br /> LOCALAGENCY <br /> CONTACT NAME INITIALS ORGANIZATION NAME EMAIL ADDRESS <br /> MICHAEL INFURNA MIC SAN JOAQUIN COUNTY LOP minfurna@sjcehd:com <br /> ADDRESS 'CONTACT DESCRIPTION <br /> 600 E. MAIN STREET <br /> STOCKTON, CA 95202 <br /> PHONE TYPE PHONE NUMBER EXTENSION <br /> PUBLIC AGENCY (209)-468-3454.. <br /> REGIONAL BOARD <br /> i <br /> CONTACT NAME INITIALS ORGANIZATION NAME EMAILADDRESS <br /> JAMES BARTON JLB CENTRAL VALLEY RWQCB(REGION 5S) jbarton@watarboards.ca.gov <br /> ADDRESS CONTACT DESCRIPTION <br /> 11020 SUN CENTER DRIVE#200 Regional Board Case Worker . <br /> RANCHO CORDOVA, CA 95670-6114 <br /> PHONE TYPE PHONE NUMBER EXTENSION <br /> FAX (916)-464-4704 <br /> OFFICE (916)-464-4615 <br /> 1 <br /> .I <br /> I <br /> httpsa/geotracker.waterboards.ca.gov/regulators/reports/urf print.asp?global id=T060770... 9/24/2009 <br />