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BOARD OF TRUSTEES - ,N JOAQUIN LOCAL HEALTH DIV"!RICT <br /> At Crow,Pres. SERVING <br /> Earl Pimento[,Vice Pres. 1601 East Hazelton Avenue San Joaquin County <br /> Tommy Joyce,Sec'y. 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 DIVISIONCityofRipon <br /> Daphne Shaw - San Joaquin County <br /> C'2O9) 468-342c 1 ty <br /> Harvey Williams,Ph.D. City of Stockton <br /> San Joaquin County <br /> A L3T H O R1 Z A T I C3" T O R E L E A S E <br /> ANALYTICAL RESULTS <br /> GEOTECHNICAL DATA <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I, THE UNDF_RSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 1200 NORTH CALIFORNIA STOCKTON <br /> (STREET ADDRESS) (CITY) <br /> HEREBY AUTHORIZE CANONrE ENGINEERING INC. <br /> (LABORATORY or CONSULTANT) <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: SAINT JOSEPH HOSPITAL <br /> (IE APPLICABLE) <br /> OWNER,/OPERATOR: <br /> (PLEASE PRINT) (TITLE) — <br /> (SI6NATWR) <br /> ADDP..ESS: , ann _Neto Tcl rnr TFORNrA <br /> (04ILIN6 ADDRESS) <br /> STOCKTON, CALIFORNIA 95204 <br /> (CITY) (STATE) (ZIP) <br /> PHONE: C 209) 462-8344 <br /> FDATE: �' <br /> EH 23 041 Revised 1/89 <br /> Administration Clinical Services Environmental Health <br /> 4Public Health Nursing <br /> 68-3400 468-3830 <br /> 468-3420 468-3860 <br /> Air Pollution Community Services Laborato <br /> 468-3470 468-3820 ry WIC <br /> 46a-3460 468-3280 <br /> AIDS Information 468-3820 <br />