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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br />AI Crow, Pres. <br />Earl Pimenta], Vice Pres <br />1601 East Hazelton Avenue <br />San Joaquin County <br />City of Manteca <br />Tommy Joyce, Secy. <br />Stockton, California 95205 <br />City of Escalon <br />James F. Culbertson <br />�� <br />City of Lodi <br />John D. Mast, M.D. <br />JOGI KHANNA. M.D.. M.P.H., DISTRICT HEALTH OFFICER <br />City of Tracy <br />Virglnia Mathews <br />Thomas Schubert, D.V.M. <br />ENVIRONMENTAL HEALTH DIVISION <br />City of Ripon <br />San Joaquin County <br />Daphne Shaw <br />(2o9) 468-3420 <br />City of Stockton <br />Harvey Williams, PhD. <br />San Joaquin County <br />AUT- HC]F:Z I ZAT I C3N TO FEEL -EASE <br />-I+ ANALYTICAL RESULTS <br />-at- GEOTECHNICAL DATA <br />-s,4- ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br />I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br />LOCATED AT 541 N. Hutchins, Lodi, CA <br />(STREET ADDRESS) (CITY) <br />HEREBY AUTHORIZE Canonie Environmental, Stockton, CA 983-1340 <br />(LABORATORY ar CONSULIAND <br />TO RELEASE ANY AND ALL ANALYTICAL RESULTS, GEOTECHNICAL DATA AND/OR <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 />TO ME OR MY REPRESENTATIVE. <br />BUSINESS NAME: <br />CS+C►eANeR.S <br />_ <br />(1E APPLICAB <br />�� <br />OWNER/OPERATOR,: <br />kun <br />BLLE) <br />-5• �RN (tJAJe�— <br />fPLEAS <br />PRINi1 <br />(TITLE) <br />(516MANAE),�r <br />ADDRESS: <br />(-t f C-hr , -S <br />(NAILING ADDRESS) <br />k <br />i) 1C.9- <br />(CI►Y) <br />(SIAIE) (ZIP) <br />PHONE: <br />(o2493) <br />365-C;2 <br />J-( T - <br />EH 23 041 Revised 1/89 <br />Administration Clinical Services Environmental Health <br />468-3400 468-3830 468-3420 <br />Air Pollution Community Services Laboratory <br />468-3470 468-3820 466-34W <br />AIDS information 486-3820 <br />Public Health Nursing <br />468-3860 <br />WIC <br />468-3280 <br />