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66�AIiD of TRUSTEES' SAN JOAQUIN LOCAL HEALTH DISTRICT �`'-"-'' SERVING <br /> City of Lodi <br /> James Culbertson,Pres. San Joaquin County <br /> Mary Anna Lore„Vke Pres. 1601 East Hazelton Avenue, P.O. Box 2009 <br /> Ban Joaquin County <br /> Patricia E.Vannucci,$ec'y. <br /> Tommy Joyce Stockton, California 95201 CNy of Escalon <br /> Earl Pl~tel CAN N� CNC it Manteca <br /> Virglnla Mathews (209) 466-6781 City of Ripon <br /> Daniel L Flores City of Stockton <br /> Tracy <br /> John D.Mast,M.D. Jogi Khanna.M.D.,M.P.H.,Dislrkf Health Ofl4cer City of Tracy <br /> San Joaquin County <br /> Gene S.Kraham <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 QLD <br /> hereby authorize �5L <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: l� f T le: <br /> Address 1 �� Iii �flG-H�ri�/�� �% hotly: <br /> Date: � / F- <br /> N ARL-.t►1 �"`o c. <br /> C -3q+a1 <br /> -3960 <br /> EH 08 05 UGT 13 <br />