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. a,:ni eF rRusTt:Es ! 1 JOAQUIN LOCAL HEALTH DI� ICT <br /> James Culbertson,Pres. SERVING <br /> Mary Anna Love,Vice Pres. 1601 East Hazelton Avenue, P.O. Box 2009 City of Lodi <br /> Patricia E.Vannuccl,Secy. <br /> Tommy Joyce San Joaquin County Earl Prmentel Stockton, California 95201 San Joaquin County <br /> Virginia Mathews City of Escalon <br /> City of Manteca <br /> (209) 466-6781 ; <br /> Daniel L Flores '' <br /> John D.Mast,M.D. City of Ripon <br /> Jog[Khanna,M.D.,M.P.H.,District Health Officer City of Stockton <br /> Gene S.Kraham rt City of Tracy <br /> San Joaquin County <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA <br /> SITE ASSESSMENT INFORMATION TA AND <br /> I , the undersigned owner and/or operator ofthe propert <br /> located at �'OL Y and/or facility <br /> hereby authorize Lt�g /3 Pos I2G,,�p ,�'-m ��� CA <br /> to release any and all analytical� <br /> 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 <br /> provided to me or my <br /> representative. <br /> ;j <br /> Owner/Operator: giA4 <br /> ,• _ �, <br /> Address /3.Ta � E; Title: <br /> /�1/iniPos� K/� Phone: y(e5-73 a p <br /> Date: <br /> l <br /> I <br /> EH 23 041 3/86 <br /> 1, <br /> I r <br /> + <br /> I I'. <br /> I <br /> i EH <br />+ <br /> + <br /> t <br />