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BOARD OF TRUSTEES _„ N JOAQUIN LOCAL HEALTH LniSTRICT <br /> At Crow-Pres. - - ----- - SERVING <br /> To myJoycevice Pres. 1601 East Hazelton Avenue San Joaquin county <br /> Tommy Joyce,Secy. <br /> Jamas F.Culbertson Stockton, California 95205 City of Manteca <br /> City of Escalon <br /> John D.Mast M.D. JOGI KHANNA, M.D., M.P.H., DISTRICT HEALTH OFFICER City of Lodi <br /> Virginia Mathews City of Tracy <br /> Thomas Schubert D.V.M. ENVIRONMENTAL HEALTH DIVISION City or Ripon <br /> Daphne Shaw <br /> Harvey Williams,Ph.D. (2(. San Joaquin County t j) 4G8-341(1 <br /> City of Stockton <br /> AUTHOR I Zres,-r I pHRELEASE San Joaquin County <br /> TU <br /> -�- ANALYTICAL RESULTS <br /> GEOTECHNICAL DATA <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 1426 BOURBON STREET STOCKTON, CA <br /> (STREET ADDRESS) (CITY) <br /> HEREBY AUTHORIZE✓ CALIFORNIA WATER LABS <br /> ftgBORHOPY or <br /> TO RELEASE ANY AND ALL ANALYTICAL RESULTS, GEOTEr:HNICAL DATA AND/OP, <br /> ENVIP,ONMENTAL/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 /> FEI , NAME: BOURBON STREET PROPERTIES <br /> (IE APPLICABLE) <br /> P..ATORr� Gary A Zimmerman <br /> (P(f 9SE-PR1NT1 Owner <br /> (SI6NATU ) <br /> ADDP..ESS: 16 5 Mission Street <br /> (AAI(IRB ADDRESS) <br /> San Francisco CA 94103 <br /> (CITY) (STATE) (ZIP) <br /> PHONE:( 415 ) 861 2179 <br /> FDATE September 25, 1989 <br /> EH 23 041 Revised 1/89 <br /> Administration Clinical Services Environmental Health <br /> 468-3400 468-3830 468-3420 Public Nursing <br /> 4668-388-38 60 <br /> Air Pollution Community Sorvices11 oratory <br /> 468-3470 468-3820 WIC <br /> 468-3460 468-3280 <br /> __ ___ AIDS Information AAA-IA9 <br />