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BOARD OF TRUSTEES SAW JOAQUIN LOCAL HEALTH DISTA9CT SERVING <br /> At Crow,Pres. San Joaquin County <br /> Earl Pimentel,Vice Pres. 1601 East Hazelton Avenue City of Manteca <br /> Tommy Joyce,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 /> Daphne Shaw (2o,3) 468-3420 City of Stockton <br /> Harvey Williams,Ph.D. San Joaquin County <br /> ^u T H OF2 I Z A T I O N T O R E L E A S E <br /> ANALYTICAL RESULTS <br /> st GEOTECHNICAL DATA <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I , THE UNDERSIGNED OWNER. AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 1146 Enterprise, Stockton, CA <br /> (STREET ADDRESS) (CITY) <br /> HEREBY AUTHORIZE FGL Environmental , Stockton, CA (209) 942-0181 <br /> (LABORATORY or CONSULTANT) <br /> TO RELEASE ANY AND ALL ANALYTICAL RESULTS, GEOTECHNICAL 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 /> HUSINESS NAME: rR g{lrA 4,Ax- 4ra4Pmtf Clea A�rc <br /> (IF APPLICABLE) <br /> OWNER./OPERATOR.: W11110on <br /> (P S E)(I) (TITLE) <br /> (SI6NATURE) <br /> ADDRESS: //yi & i' I <br /> (RAILING ADDRESS) <br /> -S r ,N <br /> (CITY) (STATE) (ZIP) <br /> PHONE: (.�;101) '4116 3 t� <br /> DATE: <br /> EH 23 041 Revised 1/89 <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 />