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DOW OF TRUSTEES SAN JOAOUIN LOCAL HEALTH DISTRICT eeavu+a <br /> Al Grow.Pres, San Jolpuln County <br /> Ud pknepsel,vice Pres, 1601 East Hazelton Avenue city Of Manteca <br /> Tommy Joyce,Secy, Stockton,California 85206 City of Escalon <br /> James F.Culbertson City of Lodi <br /> John 0.Mast M.D. JOGi KHANNA, M.D., M.P.H., DISTRICT HEALTH OFPIbER City all Tracy <br /> Virginia Mathews City or Ripon <br /> Thomas Schubert D.V.M. ENVIRONMENTAL HEALTH DIVISION Sen Joaquin County <br /> DaphnsShaw (209) 468-3420 City of Stockton <br /> Harvey%MAlams,Ph.D. San Joaquin County <br /> AUTH0M I z^-r Z ON T© F2EI. M^sm Y <br /> Fe ANALYTICAL RESULTS <br /> GEOTECHNICAL DATA <br /> -W ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I W <br /> Ir THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT_ 1120 West Pi6arter Way Stockton <br /> (STigl-AOOAESS) (CITY) y <br /> e HEREBY AUTHORIZE l 'California Water Labs <br /> (LABORATORY or CONSULTANT) <br /> TO RELEASE ANY AND ALL ANALYTICAL RESULTS, GEOTECHNICAL DATA AND/OR <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION TO THE SAN J'OAOUIN LOCAL HEALTH ' <br /> DISTRICT AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED <br /> TO ME OR MY REPRESENTATIVE. 4. <br /> r `a <br /> ,•P 1, <br /> BUSINESS NAME: Mid Cal Tractor <br /> (IF WLICABLU <br /> OWNER/OPERATOR; Jo Gilligan L� <br /> (PLEASE PRINT) (TITLE) b <br /> ir•. YVJ.�j L4\.1... <br /> ''v ( 6NAItlRE) - <br /> ADDRESS; P.O. Box 6069, 1 <br /> lNA1UNU AOBAfSS) <br /> Stockton, CA 95206 <br /> (CITY) <br /> a - (SIITE) (ZIP) <br /> PHONE. ( 209 ) 944-5714 fc <br /> im <br /> �1% EH 23 041 Revised 1/89 i <br /> Administration Clinical Services Environmental HealthPuINIC HNIIh Nursing <br /> 468.3830 488.7420 469.30g <br /> Nr Pollution Community Services laboratory yyfC.,. <br /> 4ae-0474 46e-8620 465.7460 4168.3280" <br />