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P. 2 <br /> FP01i 213 257 5083 <br /> 9 . 39 0©0l�.aHwIwo,P� 14 E3y �5��t" k'v jI <br /> BOARS of TRURTM SAN JOAQUIN LOCAL HEALTH DISTRIQT. � 11�Sd16i►IJi��^ tl"vm <br /> N Crow,Pna. 11IUU��''' g 19 WYn Jwawn COW*y <br /> Em Pvn*%W VI9a Pres. tool East Hn alton Avenue SFR 1 of M.nasa <br /> Tommy Jvy9e,94603. Btookton,OwIforN4 95205 ;,,ENTAL HEAICI 01 Es"Wo <br /> mall R,NWt W1 �pLRMiT I SLRVICES "d 1.001 <br /> John D.Mel,M.D. JOQI KNANHA, M.D., M.P.H., DISTRICT HFALYH OFFit0t Chy of Trnry <br /> alROM <br /> T>omne1 5dwDem D.V.M. ENVIRONMENTAL HEALTH DIVISION Son Joaquin County <br /> D*PN*Shaw (209) 468-3420 city of 8tooftn <br /> F{,,,�yMWIbM per, <br /> 84nJ940WnCvunly <br /> AI.JTMc3m I ZAT I r-111V 'r C3 MmL..K:A&3m <br /> 4+ ANALYTICAL RESULTS <br /> +1, OEOT60HNICAL DATA <br /> •0+ ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> 1 , THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT E. tlq-�1-a R 't- SACR qM EN7F0 S t,QE'C-TS <br /> (ILgEr IIIA f!) (City) . <br /> HERESY AUTHORIZE- f- <br /> 44I0AAf0AY or COASOLIAAi) <br /> TU RELEASE ANY AND ALL ANALYTICAL RESULTS, SEQTEsCHNICAL DATA AND/OR <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 REPRESENTATIVE. <br /> BUSINESS NAME; A-ra"tSotJ (!So. <br /> (!F A/lllCAILE) <br /> OWNER/OPERATOR; <br /> tEAIE IIIAl) iE) <br /> ' gge{�'F 66 <br /> 2L3 <br /> (flIMA tlfE) <br /> ADDRESS; 5 .20c) a. .SHE t LA S4- <br /> (!Hill! AI/Aiff) <br /> LOS A�,Js CA• oo4 >� <br /> (CIIF) (fIA1E) (ZIP) <br /> PHONE( <br /> DATE:; <br /> 4 23 041 Rervisnd 1/89 <br /> A"nlatretlon CIlnloai Se Arne Environmental H"M Pudic Haa)Ih Nursing <br /> 461511.3100 46M.38M 4M•3120 11511.s140 <br />