Laserfiche WebLink
i <br />BOARD OF TRUSTEES <br />Al Crow, Pros. <br />Earl Plmentel. Vice Pres. <br />Tommy Joyce, Secy. <br />James F. Culbertson <br />John D. Mast, M.D. <br />Virginia Mathews <br />Thomas SchuboM D.V.M. <br />Daphne Shaw <br />Harvey Williams. PhD. <br />SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br />7601 East Hazelton Avenue San Joaquin County <br />City of Manteca <br />Stockton, California 95205 City of Escaion <br />City of Loot <br />JOGI KHANNA. M.O., M.P.H., DISTRICT HEALTH OFFICER City of Tracy <br />Coy of Ripon <br />San Joaquin County <br />City of Stockton <br />San Joaquin County <br />AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br />SITE ASSESSMENT INFORMATION <br />I, the undersigned owner and/or operator of the tproperty and/or facility <br />located at 00 Lodi' (4- 'M ->Y0 <br />hereby authorize <br />to release any and all analytical results, geotechnical data and site <br />assessment information to the San Joaquin Local Health District as soon <br />as it is available and at the same time it is provided to me or my <br />representative. <br />Date: <br />Eli 23 041 3/86 <br />Administration <br />466-3400 <br />Afr Pollution <br />469.34)0 <br />ClInicai services Environmental Health <br />466-9690 466-3420 <br />Community SarAces laboratory <br />466-7620 469.3460 <br />e CQ 33 3 pc)35— <br />Public Health Nursing <br />466-3660 <br />Wfc <br />466-3260 <br />