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J U L-- 2 E — 8 9 WED 1 4 : 1 3 M O O R E PETROLEUM P - 04 <br /> BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> San Joaquin County <br /> Al Crow,Prat. 1601 East Hazelton Avenue city of Manteca <br /> Earl Pimentel,Vice Pres. Stockton,California 95205 City of Etralon <br /> Tommy Joyce,Secy. City of Lodi <br /> James F.CulbodsonCi of Trac <br /> John D.Mast,M 0. JOGI KHANNA, M.D., M.P.H., DISTRICT HEALTH OFFICER City of Ripon <br /> Vlrpinis MathewsENVIRONMENTAL HEALTH DIVISION San Joaquin County <br /> Thomas Schubert D.V.M. City of Stockton <br /> Daphne Shaw (209) 468-3420 San Joaquin County <br /> Harvey Williams,Ph.D. <br /> AUTHOR I Z^-r ION 'TO FtEL1=ASe <br /> it ANALYTICAL RESULTS <br /> ae GEOTECHNICAL DATA <br /> +a ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> Ir THE: UNDERSIGNED OWNER AND/OR OPERATOR. OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT A/goo G✓ MA IV E--cA <br /> (STREET ADDRESS) 0110 <br /> HEREBY AUTHORIZE LONSU �+� -S c" <br /> (tAD0RAT0RP or COMSDUANi) <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: , AN>'S xxC) � <br /> OF APPLICABLE) <br /> OWNER/OPERATOR: <br /> PLEASE PRINT) IIIE) <br /> ��- <br /> 1( TUR ) <br /> ADDRESS: IJ 0 62 <br /> (NAILING ADDRESS) <br /> C Ar/711 <br /> (City) (STATE) (ZIP) <br /> PHONE < 202 835 2750 <br /> DATE: <br /> EH 23 041 Revised 1/133 <br /> Administration Clinical Servicos Environmental Health Public Health Nurslnp <br /> 468.5400 468.9830 468.5420 469-3060 <br /> Air Pollution Community Servlces laboratory WIC <br /> 460-9470 468.3820 468-5460 468.3"0 <br /> ACOS Information 468-9820 <br />