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BOARD OF TRUSTEES <br /> Pr <br /> At Crow,Pres. ON •AQUIN LOCAL HEALTH DOYRAV <br /> Earl Plmentel,Vice Pres. 7601 East Hazelton Avenue SERVING <br /> Tommy Joyce,Sec'y. San Joaquin County <br /> James F.Culbertson Stockton, California 95205 City of Manteca <br /> John D.Mast,M.D. JOG[ KHANNA, M.D., M.P.H., DISTRICT HEALTH OFFICER City t Escalon <br /> Lodi <br /> Virginia Mathews City of Lodi <br /> Thomas Schubert,D.V.M. ENVIRONMENTAL HEALTH DIVISION' &C City of Tracy <br /> Daphne Shaw <br /> tY Of Ripon <br /> Harvey Williams,Ph.D. (209) 468-3420 ' �P Joaquin County <br /> AUT" CityofStockton <br /> REL <br /> O = Z A T = O IV T O 9p 5rn JOayuht County <br /> AE <br /> x ANALYTICAL RESULTS '� <br /> F MST,,,` ✓ <br /> GEOTECHNICAL DATA /5����cESgUy <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> Ir THE UNDERSIGNED OWNER AND/OP, OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT cf;'at7,7 <br /> HEREBY AUTHORIZE (STREET ADDRESS) <br /> (CITY) <br /> (LABORATORY or CONSULTANT) <br /> TO RELEASE ANY AND ALL ANALYTICAL RESULTSr 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: <br /> !%'TOiY <br /> (IF APPLICABLE) <br /> OWNER,/OPERATOR: SE/ 1304-p CO FAA© <br /> fJ <br /> (PLEBE asrvr) <br /> L (I It <br /> (SURATURE) <br /> ADDRESS: 3Z(3 S, <br /> I'NAILINS AppRESS) <br /> j��CK7�Jvl <br /> (CITY) <br /> (STATE) (ZIP) <br /> PHONE: (2d9 ) z/S-z- <br /> DATE: <br /> EH 23 041 Revised 1/89 <br /> Administration Clinical Services <br /> 468-3400 468-3830 Environmental Health Public Health Nursing <br /> 468-3420 <br /> Air Pollution 468-3860 <br /> Community Services <br /> 468-3470 468-3820 Laboratory WIC <br /> 468-346o 488-3280 <br /> AIDS Information 468-7870 <br />