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:14 <br /> 50ARD OF TkUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> lames Cultxrtson, Pros. City of Lodi <br /> Aary Anna Love,vice Pres. 1601 East Hazelton Avenue, P.O. Boz 2009 San Joaquin County <br /> Patricia E.Vannuccl,Soc'y. San Joaquin County <br /> Tommy Joyce Stockton, Calltornia 95201 <br /> City of Escalon <br /> =art Plmentai <br /> nteca <br /> llrginta Mathews (209) 466-6781 CttCity ofy of Ripon <br /> t)anief L Floret <br /> City of Stockton <br /> John D.Mast, M.D. Jogl Khanna,M.D.,M.P.H.,Disb"Health Officer City of Tracy <br /> Sen•S.Kraham <br /> 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 ) 16 3 54nry >V ., Me.,, St' ,94 <br /> hereby authorize LGN py1 fe- <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: 1 Title:&. <br /> AddressZ.3 U Phone :(HSS) �Gy�77 <br /> eT-Its <br /> Date : <br /> f <br /> j <br />:I <br />.I <br /> EH 08 05 UGT 13 <br />