Laserfiche WebLink
D of TRIISTEn SAN ,IUAOUIN LOCAL HEALTH DISTRIL,T SERVING <br /> pr s. San Joaquin County <br /> A Pimento.Vice Pres. 1601 East Hazellon Avenue City of Manteca <br /> Tommy Joyce,sec'y. Stockton, California 95205 Ciry of Eecalon <br /> Jonm F.CulbMeon City of Lodl <br /> John D.Meal,M.D. JOOI KHANNA, M.D., M.P.H., DISTRICT HEALTH OFFICER City of Tracy <br /> virglnls Matirows City of Ripon <br /> Thomas Schubert D.V.M, ENVIRONMENTAL HEALTH DIVISION Sen Joaquin County <br /> Daphne Show (2o3) 468-3420 City of Stockton <br /> Harvey Wllllems,Ph.D. Sen Joaquin County <br /> AUTHOFZ I ZAT I Ohl TO 1—iELEASE <br /> i4- ANALYTICAL RESULTS <br /> -se- GEOTECHNICAL DATA <br /> 414- ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I , THE UNDERSIGNED OWNER AND/OP, OPERATOR OF THE PROPERTY AND/OP, FACILITY <br /> LOCATED AT _67$00 WEST- Cc l-,-JM.1 C(.li(L S-Mc��N�.1 q� <br /> I CA ,Sa <br /> (SIAEEI AIONESS) r WIN <br /> HEREBY AUTHORIZE e-- a (`1F (A' ,A T �Pc,t', <br /> (LABORATORY or CONSILTAND <br /> TO RELEASE ANY AND ALL ANALYTICAL 'RESULTSr GEOTECHNICAL DATA AND/OR <br /> 1 <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION TO THE SAN JOAQUIN LOCAL HEALTH <br /> DISTRICT AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED <br /> TO ME OR MY REPP.ESENTA-rIVE. <br /> BUSINESS NAMES z�K/byi 6 1111 <br /> // <br /> (if APPLICABLE) <br /> / <br /> OWNER/OPEP,ATORS 5 I�6)d /F <br /> /(PLEASE ?$IN[) (TITLE) <br /> (7NAIBREI <br /> ADDRESSS �� k'12 <br /> (NAILING AI�IHSSS) <br /> (CIIN / (SIAIV (r1N <br /> PHONE e <br /> DATEt LQ C / � <br /> EH 23 041 Revi ed 1/E39 <br /> r <br /> A^_fr!c!vratlon Clinical Services Environmental health Public Hoolth Nursing <br /> 468-9400 468-3830 468-3420 469-3860 <br /> Air Pollution Community Services Laboratory WIC <br /> 468.9470 488-3820 4138.3400 468-3200 <br /> AIDS Information 468-3820 <br />