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BOARD Ot TRUSTEES SAN ZMAOUIN LOCAL HEALTH DISTRILT SERVING <br /> Al Crow,Pres, San Joaquin County <br /> Earl Pimenlel,Vice Pres, 1601 East Hazelton Avenue City of Manteca <br /> Tommy Joyce,Body. Stockton, California 85205 CIry of Eacalon <br /> James F.Culbertson City o1 Lodi <br /> John 0.Me34 M.D. 4001 KHANNA, M.D., MAX, DISTRICT HEALTH OFFICER City of Tracy <br /> Vlrpinla Mathews Oily of Ripon <br /> Thomas Schubert,D.V.M. ENVIRONMENTAL HEALTH DIVISION San Joaquin County <br /> Daphne Shaw (209) 468_342.0 City of Stockton <br /> Harvey Williams,Ph.D, San Joaquin County <br /> AU-r"0R I z^-r Z 0h! -ro REiEAse <br /> 4- ANALYTICAL RESULTS <br /> '+a• GEOTECHNICAL DATA <br /> ►e ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATE(? AT 455 West Grant Line Road Tracy . <br /> (STREET ADDRESS) (CITY) <br /> HEREBY AUTHORIZE American Environmental Management Corporation <br /> (l)1DORATORY or CORSDUART) <br /> TO RELEASE ANY AND ALL ANALYTICAL RESULTS, GEOTECHNICAL DATA AND/OR <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION TO THE SAN J'OAQUIN LOCAL HEALTH <br /> DISTRICT AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT 18 PROVIDED <br /> TO ME OR MY REPRE=SENTATIVE, `, <br /> BUSINESS NAME: 7-11 r <br /> N; <br /> (!f DAtfllCASlE) <br /> Dave Lamm, Southland Corp.OWNER/OPERATORS �'v'y•%� � - <br /> tEASf iATR!) (TITLE) u <br /> (S AIUREI <br /> ADDRESS, 655 University Drive , Suite 104 k <br /> (RAIEIRB ADDRESS) <br /> Sacramento, 3 .1r CA 95825 <br /> (City) (STATE) (ITP) <br /> ( <br /> PHONE: ( 916 ) 927-8155 <br /> DATE: ' <br /> EH 23 041 Revised 1/89 <br /> Administration Clinical Services Environmental Health Public Health Nursing <br /> 468.3400 468.3800 488-3420 468.3360 <br /> Air Pollution Community Services Laboratory wt0 <br /> 489.0470 468.3620 408.3460 466-3200 , <br /> `mo .... <br /> woaJ <br />