Laserfiche WebLink
• I <br /> or TRluT1W SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> San Joaquin County <br /> Pre 1801 East Hazelton Avenue City d Manteca <br /> FID&pNw <br /> enbt Vlq y. Stockton,California 95205 city of Escalon <br /> Joyea.BwY. City d Loa. <br /> askM..Mast M.D. '. JOGI KHANNA, M.D., N.P.H., DISTIIICT HULTH OFiIblR Clty d Tracy <br /> Mathews I City of Rlpon <br /> s Schubert O.V.M. ENVIRONMENTAL HEALTH DIVISION Ban Joaquin County <br /> Shaw j (209) 468-3420 City of Stockton <br /> Hovey 1NslN.PtLD. f San Joaquin County <br /> AUTHOR I Z^-r I mm -11- <br /> ANALYTICAL <br /> ANALYTICAL RESULTS <br /> 111 GEOTECHNICAL DATA <br /> +a ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I , THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTYIAND/OR FACILITY <br /> LOCATED AT / J' t " <br /> TlJ>J <br /> (IIIEEI 1111E (� 11 k J /2 <br /> HEREBY AUTHORIZE <br /> E A ow Ar or C011I11A11) <br /> R <br /> TO RELEASE ANY AND ALL ANALYTICAL RESULTS, GEOTECHNICAL DATA AND/O <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 /> t,TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME4 <br /> (if AI/LICAI ) <br /> OWNER/OPERATOR2 LA) obi .' e <br /> (ILEA IAII (11►LE1 <br /> -�—�• <br /> 0 ADDRESSt 7 <br /> (IA1111 muss) <br /> 4-2s � 9 <br /> (c►rr) (SIAIE) ►111 <br /> PHONES <br /> DATE if �2 <br /> EH 23 041 Revised 1/89 <br /> AdaMatntion Clinical Servkas Environmental Heatth Pubso Heaeh Nursing <br /> 466-1400 468-3830 468-3420 160.98110 <br /> Air Pollution Co nrrtunity SerAces laboratory VVIC <br /> 460-9470 468-3820 465-3460 1611-3280 <br /> AIDS Inlormadon 468-3820 <br />