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OARD OF TRUSTEES <br />ames Culbertson, Pres. <br />lary Anna Love, Vice Pres. <br />atricia E. Vannucci, Secy. <br />ommy Joyce <br />art Pimentel <br />irginia Mathews <br />aniel L. Flores <br />ohn D. Mast, M.D. <br />;ene S. Kraham <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1601 East HazeIton Avenue, P.O. Box 2009 <br />Stockton, California 95201 <br />(209) 466-6781 <br />Jogi Khanna, M.D., M.P.H., District Health Officer <br />SERVING <br />City of Lodi <br />San Joaquin County <br />San Joaquin County <br />City of Escalon <br />City of Manteca <br />City of Ripon <br />City of Stockton <br />City of Tracy <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 CooK <br />hereby authorize <br />Vap 3/41 44 I 0/0 HOLT Zo HOLT 1 CA (s(,-ollt4,2e..) <br />4S"" TEsCoswCfrCLE 5AOTA 20SA 1 C# 9 54 0 1 A K.)PiTEC LAB.09-4-1-t <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: LZz-1-ri a-7 <br />Address 850 .:5o, /76:-z94Mc <br />Z. / ifmenJol- 7a, 7 <br />Title: /17,40.4isef2- fiva• <br />Phone: <br /> <br />Date: Oc...7 -02 /B7 <br />EH 08 05 UGT 13