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BOARD OF TRUSTEES S' N JOAQUIN LOCAL HEALTH Dl�'-EIICT <br /> AI Crow,Pres. SERVING <br /> Earl yentel,Joyce Vice Pres. ~ <br /> Tommy Joyce1601 East Hazelton Avenue San Joaquin County <br /> ,Selly. Stockton, California 95205 City of Manteca <br /> James F.Culbertson City of Escalon <br /> John D.MasL M.D. JOGI KHANNA, M.D., M.P.H., DISTRICT HEALTH OFFICER City of Lodi <br /> Virginia MathewsThomas City of Tracy <br /> Daphne Shaw D.v.M. ENVIRONMENTAL HEALTH DIVISION City of Ripon <br /> Daphne Shaw ( ,0 ) ,o. San Joaquin County <br /> Harvey Williams,Ph.D. 468—��12i I <br /> City of Stockton <br /> A lJ T H O R I Z A T IONT O RELEASE San Joaquin County <br /> E:: IANALYTICAL <br /> 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 1800 North California Stockton <br /> (STREET ADDRESS) (CI <br /> HEREBY AUTHORIZE Canonie Engineering InC.y� <br /> (L0ORRIORY or tvAbfjLjAAjl <br /> TO RELEASE ANY AND ALL ANALYTICAL RESULTS? GEOTECHNICAL DATA AND/OR <br /> ENVIP,ONMENTAL/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 /> =^—' �!��rrs Construction <br /> (IF APPLICABLE) <br /> OWNER,/OPERATOR,: Donald Roek President <br /> (PLEASE PRINT) / (TITLE) <br /> ISISNRIUREJ <br /> ADDRESS: P.O. Box 30038 <br /> (NAILIN6 ADDRESS) <br /> Stockton, Californai 95213 <br /> (CITY) (STATE) (ZIP) <br /> PHONE: ( 209 ) 464-8344 <br /> ------------------ <br /> DATE: , I— d�� V <br /> EH 23 041 Revised 1/89 <br /> Administration Clinical Services Environmental Health <br /> 468.3400 468-3830 468-3420 Public Health Nursing <br /> 468-3860 <br /> Air Pollution CommunityServices Laboralo ' <br /> 468-3470 468-3820 468-3460 WIC ' <br /> 468-3280 <br /> AIDS Information 468-3890 <br />