Laserfiche WebLink
BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> City of Lodi <br /> James Culbertson, Pres. County <br /> Patricia E. Vannucci, Secy. Sen Joaquin County <br /> Anthonette Van Spronsorl 1601 East Hazelton Avenue, P. O. Box 2009 City of Eanteca <br /> Earl Pimentel Stockton, California 95201 �I�r 'tl City or Manteca <br /> Fern Bupbee 209146"781I7 L�� olRlpon <br /> Daniel L. Flores I:[(�l.Gd.'VV t Stockton <br /> of Tracy <br /> John D. Mast, M.D. <br /> William J. Wade Jopl Khanna, M.D., M.P.H., District Health Officer JAN 3 1 �-8anJoaquinCounty <br /> MJoaquin County <br /> Mary Anna Love <br /> EWRONfAINTAI HEALTH <br /> PERMIT/SERVICES <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> I , the undersigned owner and/or "op�era,tolr of the property and/or facility <br /> located at ay 155 (iflP, 1 kdQLLQCA) EDPD T9,ACSC1afl <br /> hereby authorize -C�J� W ATE 9Z L_A& i "V Qe--s ), �1A <br /> to release any and all analytical results, geotechnical data and site <br /> assessment information to the Sari Joaquin Local Health District as soon <br /> as it is available and at the same time it is provided to me or my <br /> i representative. <br /> Underground Tank Coord. <br /> Owner/Operator: Charleae RroWn ___ Title: ASSt Cat Adm. <br /> Address P.O. Box 20.48 _ <br /> Phone: 948-7406 <br /> Sacramento CA 95201 — <br /> Date: <br /> e <br /> EH 08 05 <br />