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- HOARD OF TRUSTEES SJOAQUIN LOCAL HEALTH DirICT SERVING <br /> Al Grow,Pres. San Joaquin County, <br /> Earl Pimentel,vice Pres. 1601 East Hazelton Avenue city of Manteca'j,- <br /> rommyJoyyce,sec'y. Stockton, California 95205 CtyofEsabn <br /> James F.Culbertson Of John D.Mast M.D. JOG] KHANNA, M.D., M.P.H., DISTRICT HEALTH OFFICER City of Tracy,=; . <br /> Vlrglnla Mathews City of Ripon`r <br /> Thomas Schubert.D.V.M. ENVIRONMENTAL HEALTH DIVISION . . <br /> Daphne Shaw San Joaquin Coiurty; r <br /> (2i 9) 4G8-34201 City ofSiockton` ' <br /> Harvey Williams,Ph.D. San Joaquin'County <br /> AUTHOR I ZAT I ON TO f—iELEASE <br /> ANALYTICAL RESULTS <br /> GEOTECHNICAL DATA <br /> -W- ENVIRONMENTAL/SITE ASSESSMENT INFORMATION ~ <br /> I, THE UNDEP.SIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OP. FACILITY <br /> LOCATED AT d ,rye /O?�ys I`Jec� 4/e s <br /> %�.9,e/C <br /> (STREET DDRESS) (CT YJ <br /> HEREBY AUTHORIZE 7l� <br /> IIABORAIOP,Y o�OXSUUAXTJ °' <br /> TO RELEASE ANY AND ALL ANALYTICAL RESULTS, GEOTECHNICAL DATA AND/OP. <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION TO THE SAN JOAQUIN LOCAL HEALTH `Mv; <br /> DISTRICT AS SOON AS I'r IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED {'( <br /> TO ME OR MY REPRESENTATIVE. �Y <br /> BUSINESS NAME: <br /> (Tf APPIICABtEJ r <\ _°I <br /> OWNER/OPERATOR. — S' <br /> (KEASE PRIXIJ (ITIIE) <br /> (SWAT URE) <br /> 3�. <br /> ADDP,ESS: z!/mss' <br /> (XAl(IR6 ADDRESS) _;; <br /> 92 We _ cf� —�sa Ya- <br /> (CITY) (STATE) U5) <br /> PHONE: <br /> Is.' s <br /> DATE: <br /> - a0 <br /> EH 23 041 Revised 1/89 <br /> Administration Clinical Services Environmental Health <br /> 468-3400 468-3830 Public Health Nursing <br /> 468-3420 468-386 <br /> Air Pollution Community Sorvicos Laboraio <br /> 468-3470 468-3820 468-3460 NnC <br /> 468-3280 <br />