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SCARD OF TRUSTEES SAN .)AGUIN LOCAL HEALTH DISTRI, SERVING <br /> At Crow,Pres. Sen Joaquin County <br /> Earl Pimenlet,Vice Pres. 1601 East Hazelton Avenue11�� City of Manteca <br /> Tommy Joyce,Secy. Stockton,California 85205 SEP t(, .l RECD City of Escalon <br /> James F.Culbertson I City of Lodi <br /> John D.Most,M.D. JOG) 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 (209) 468-3.120 City of Stockton <br /> Harvey Williams,Ph.D. San Joaquin County <br /> A U T H O R I Z A T I O N T O R E L F—='^S E <br /> ANALYTICAL RESULTS <br /> +f GEOTECHNICAL DATA <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> Ir THE UNDERSIGNED OWNER AND/OR OPERATOR, OF THE PROPERTY AND/OP, FACILITY <br /> LOCATED AT 301 Crant 'ne Rr' . _cv . 53 7' <br /> (SIREEI ADDRESS) <br /> HEREBY AUTHORIZE Semco - James C. Bateman Petroleum Services, Inc. <br /> ((ABORAIORY or CONSDIIANI) <br /> TO RELEASE ANY AND ALL ANALYTICAL RESULTSr GEOTECHNICAL DATA AND/OR <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION TO THE SAN JOAQUIN LOCAL HEALTH <br /> DISTRICTIAS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED <br /> TO ME OR MY REPRESENTATIVE. <br /> t ' <br /> i <br /> BUSINESS NAME• <br /> (IE APPLICABLE) <br /> OWNER/OPERATOR: City of Tr .e ' Director of Public Works <br /> (PLEASE PRIME (I11LE) <br /> (SURAIURE) <br /> ADDRESS: 500 S . Tr-o-,' ;llvc . <br /> (RAILING ADDRESS) <br /> 6 <br /> (CIEY) (SIAIE) (E1P) <br /> PHONE: Gee ) ?.,36- 16-;1' <br /> DATE: <br /> EH 23 041 Revised 1/09 <br /> Administration Clinical Services Environmental Health Public Health Nursing <br /> 468-3400 468-3830 468.3420 469-3860 <br /> Air Pollution Community Services Laboratory WIC <br /> 468-3470 468.3820 468-3400 468.3280 <br />