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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> AI Crow,Prea, <br /> . - Earl Plmentel,MCC Pres. 1601 East Hazelton Avenue SERVINt <br /> Tommy Joyce,S«'y, San Joaquin Count <br /> James F.Culbertson Stockton, California 95205 City of Maniac. <br /> John D.Mask M.D, City 01 Escalo. <br /> Virpinla Mathews JOGI KHANNA, M.D., M,PJL, 013TRICT HEALTH OFFICER Cly of Lo' <br /> Thomas Schubark DN.M• ENVIRONMENTA Cly of Trac <br /> Daphne Shaw L HEALTH DIVISION City of RIOo, <br /> Hervey Williams.Pl (209) 468-3420 San Joaquin Counr <br /> City of Slocktor <br /> '4 LJ T H Q FZ I Z A`r = Ip IVSan Joaquln Count; <br /> TO R�I...EAB� <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 DC7/ Li� ✓rt £j �7 K <br /> HEREPY AUTHORIZE fSTAEfI A04R S! (C/!y1 <br /> (LAAORAl0A1 orr)Q015tlL1A1T1 2 l �� -(cif <br /> TO RELEASE ANY AND ALL ANALYTICAL RESULTS, GEOTECHNICAL DATA ANA/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 /> FOWNER/OPERATOR: <br /> NAME: _. J!. SOSEp ,S �f0 <br /> fir AlPUCA4lE1 JEPk�' (}/(/ �Jj6,y7/1/tq�/�'L� SC�OOAE <br /> (PLEASE PRi1l1 <br /> r <br /> (SWA <br /> ADDRESS: <br /> (0411114 A000ESS) - — •-------. <br /> n6A/ � -,?��� <br /> (curl rrrerEl " rzul <br /> PHONE: aro 4 <br /> DATE: <br /> EH 20 041 Revised 1/09 <br /> Administration Clinical Services Environmental Heath <br /> Public Hoaltn Nursing <br /> 4664400 468.9890 <br /> 468-5920 488.5880 <br /> Air Pollution Community Services Laborato <br /> 488.5470 468.9820 4U-5460 Wi - <br />