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� � •,. SERVING <br /> BOARD OF TRUSTEES SAN JOAOWN LOCAL HEALTH DISTRICT city of Lodi <br /> James Culbertson,Pres P Q Box 2009 San Joaquin County <br /> Mary Anna Love Vice Pres 1601 East Hazelton Avenue, San Joaquin county <br /> Pericta E Vannucci,Secy city of Escalorn <br /> 6y Joyce Stockton, California 95201 city of Manteca <br /> imentelCity of Ripon <br /> Virginia Mathews (209) 466-6781 City of Stockton <br /> Daniel L FloresCity of Tracy <br /> John D Mast,M D Jagi Khanna, M D,MPH,District Health Officer San Joaquin County <br /> Gene S Kraham <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS , GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> 1 , the • ndp8j `�d owner and/or operator of the property and/or facility <br /> located a t 2 5'0 A) 4S o37 W12 <br /> hereby authorize ,zv��z,�,L Cr/hftii- n4-aTs c <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 /> Ap f A— Tit �s <br /> Owner/Operator le <br /> Address 00 L.0/Gc'7"t aeo Phone <br /> poc.jnl-eC/a dL o <br /> Date /z-/9- 0-7 <br /> lluN k :�f u Pt4o <br /> &6vG0&t O <br /> t <br /> Eli 08 05 UGT 13 <br />