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BOARD OF TRUSTEES SO JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> AI Crow.Pres, <br /> Ead Pimentel,vice Pre& 1601 East Hazelton Avenue San Joaquin County <br /> C of Manteca <br /> James <br /> sF.Cine,Secy, Stockton, California 95205 City of Escalon <br /> James F.Culbertson City of Lodi <br /> John D.Mast,M.D. JOGI KHANNA, M.D., M.P.H., DISTRICT HEALTH OFFICER City of Tracy <br /> Virginia Mathews City of Ripon <br /> Thomas Schubert D.V M. ENVIRONMENTAL HEALTH DIVISION San Joaquin County <br /> Hahne Shawrust'Williams,PhD. (209) 468-3420 City of Stockton <br /> San Joaquin Count' <br /> A U T H O R I Z A T I O N T C3 R E L E A S E <br /> 'x ANALYTICAL RESULTS <br /> GEOTECHNICAL DATA <br /> +� ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER, AND/OR OPERATOR OF THE PROPERTY AND/OP, FACILITY <br /> LOCATED AT 1340 West Charter Way Stockton California 95209 <br /> (STREET ADDRESS) (CITY) <br /> HEREBY AUTHORIZE Waterworks 1710 Main Rr r Fa : r . • ')no :z3g-g5A7 <br /> (LABORATORY or CONSOLTANT) <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: Kooyman Trucking Inc. <br /> (IF APPLICABLE) <br /> OWNER/OPERATORPON SANTOS AGENT. <br /> OLEASE PRINT) (TITLE) <br /> (SI6141111 ) <br /> ADDRESS: 1112 N. E1 Dorado Street <br /> (RAILING ADDRESS) <br /> Stockton, Ca. 95204 <br /> (CITY) (STATE) (ZIP) <br /> 209 948-8701 <br /> PHONE: ( XXX <br /> DATE: <br /> EH 23 041 Revised 1/E39 <br /> Administration Clinical Services Environmental Health Public Health Nursing <br /> 468-3400 468-3830 468-3420 468-3860 <br /> Air Pollution Community Services Laboratory WIC <br /> 468-3470 468-3820 468-3460 468-3280 <br /> AIDS Information 468-3820 <br />