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BOARD OF TRUSTEES Sr-:\I JOAQUIN LOCAL HEALTH Dh"4ICT <br /> Al Crow,Pres. SERVING <br /> Earl Pimentei,vice pros. 1601 East Hazelton Avenue San Joaquin County <br /> Tommy Joyce,Secy. Stockton, California 95205 City of Manteca <br /> James F.Culbertson City of Escalon <br /> John D.Mast,M,D, JOGI KHANNA, M.D., M.P.H., DISTRICT HEALTH OFFICER City of Lodi <br /> Virginia Mathews City of Tracy <br /> Thomas Schubert,D.V.M. ENVIRONMENTAL HEALTH DIVISION City of Ripon <br /> Daphne Shaw San Joaquin County <br /> Harvey Williams,Ph.D. (209) 468-3420 City of Stockton <br /> San Joaquin County <br /> AUTHOF;z I ZAT I oN TQ ReL.EASE <br /> - - ANALYTICAL RESULTS <br /> - GEOTECHNICAL DATA <br /> -�- ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> Ir THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 2yOQ )r pf Slmck-Dr, <br /> (STREET DDRESS) (CITY) <br /> HEREBY AUTHORIZE T As - i- <br /> (LABORA1 RY or CONSDIIANT) <br /> TO RELEASE ANY AND ALL ANALYTICAL RESULTS, GEOTECHNICAL DATA AND/OR <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION TO THE SAN JOAQUIN LOCAL HEALTH <br /> DISTRICT AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED <br /> TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: CRY'S �y�L [01%54'gn+ <br /> fiF APPLICABLE) <br /> OWNER/OPERATOR: Mr. Ulycess Williams <br /> (PLEASE PRINT) (TITLE) <br /> sNATI1RE) <br /> ADDRESS: &rsGt` _=-nc 5330 �r�n,rase Dr s I 2 Z8 <br /> (RAILIN6 ADDRESS) ,.. <br /> Ftitr Oaks C 1-! `T S 6 2-8 <br /> (CITY) (STATE) (ZIP) <br /> PHONE: ( 9 1 <br /> DATE: Febrvq 2.q <br /> EH 23 041 Revised 1/89 <br /> Administration Clinical Services Environmental Health public Health Nursing <br /> 468-3400 468-3830 468-3420 468-3860 <br /> Air Pollutlon Community Services Laboratory WIC <br /> 468-3470 488-3820 468-3460 468-3280 <br /> AIDS InfOrmatlon 468-3820 <br />