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BOARD <br /> „OF TRUSTEES SAN �AOUIN LOCAL HEALTH DISTRIij4 SERVING <br /> Jarnes-C� pres. city of Lodi <br /> Mary Anne Looe,vice Pres. 1601 East Hazefton Avenue,P.O.Box 2009 San Joaqum county <br /> Pawkila E.varmwocl.See'y. Stockton,C&Momta 95201 Sen city Eaeaioaquin a <br /> To"W"r Joyce 01 , <br /> Tarrm <br /> Ead Pkner" C?tr d Manteca <br /> vf►9inia Mathews (209)466-6781 City of R4Poo <br /> Oanief L Rot" Chy of Siockion <br /> John O.Mast M.O. Jo9i Khanna.M.D.M.P.H.,OisHtci Hsaffh of6c« 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 _ i .-yQ N Alf i;;) �rt ek �rn C,l <br /> hereby authorize _ (B;O5 u S+- e:M_5 M&%8-4-012 iAAi0 A+-- Sn --of,r� <br /> to release any and all analytical results. geotechnical data and site <br /> assessment information to the San Joaquin Local Health District as soon J <br /> as it is available and at the same time it is provided to me or my <br /> representative. �. <br /> Own /Opera to _ w� �5\}� i t e• <br /> Addre a, p tO A V vi�>' Phone: ,-209 cI y o j <br /> Date: 1-a.3 -gg <br /> EH 08 05 UGT 13 <br />