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. /BOARD OF TRUSTEES • <br /> S JOAQUIN LOCAL HEALTH DISTRICT <br /> AI Crow,Pres. SERVING <br /> Tommy Joyce <br /> Earl yentel,Joyce Vice Pres. 1601 East Hazelton Avenue San Joaquin County <br /> ,Secy. <br /> James F.Culbertson Stockton, California 95205 City of Manteca <br /> John D.Mast,M.D. City of Escalon <br /> Virginia Mathews JOGI KHANNA, M.D., M.P.H., DISTRICT HEALTH OFFICER City of Lodi <br /> Thomas Schubert,D.V.M. City of Tracy <br /> Daphne Shaw ENVIRONMENTAL HEALTH DIVISION City of Ripon <br /> Harvey Williams,Ph.D. . (209) 468-3420 San Joaquin County <br /> City of Stockton <br /> AIJTHOFZ I ZAT = ON TOR E L E A SE San Joaquin County <br /> x ANALYTICAL RESULTS <br /> GEOTECHNICAL DATA <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> Ir THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT �16 /V. nzo d�TA <br /> n <br /> (SIREEI A DRESS) �J<�vfull/) <br /> HEREBY AUTHORIZE k <br /> (LMORATORY or NS <br /> TO RELEASE ANY AND ALL ANALYTICALRESULTS, GEOTECHNICAL DATA AND/OR <br /> ENVIP,ONMENTAL/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: VAU-EV CAJ�( <br /> (IF 4PPCICA8IE) <br /> OWNER/OPERATOR: -PAT-F1 ST) <br /> j/'J oQ (111(E1 <br /> (S16NAIURf) <br /> ADDRESS: <br /> (NAICIND ADDRESS) <br /> �TDC C� 7aY-! <br /> lull/) (SIAIf) (ZIP) <br /> PHONE: <br /> EH 23 041 Revised 1/89 <br /> Adminis ration Clinical Services <br /> 468-3400 Environmental Health public Health Nursing <br /> 468-3830 468-3420 <br /> Air Pollution 468-3860 <br /> 468-3470 Com 468'38 OrServices laboratory WIC <br /> 468-3460 468-3280 <br /> AIDS Information 468-3820 <br />