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BOARD <br />• • <br />OF TRUSTEES <br />AI Crow, Pres. <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />entel, <br />Earl y Joyce vice Pres. <br />Tommy Secy <br />1601 East Hazelton Avenue <br />F. <br />James F. Culbertson <br />Cine, <br />Stockton, California 95205 <br />John D. Mast, M.D. <br />Virginia Mathews <br />JOGI KHANNA, M.D., M.P.H., DISTRICT HEALTH OFFICER <br />Thomas Schubert D.V.M. <br />Daphne Shaw <br />ENVIRONMENTAL HEALTH DIVISION <br />Harvey Williams, Ph.D. <br />_ (209) 468-3420 <br />A lJ T H O R I Z A T I O N T O R E L EAS E <br />ANALYTICAL RESULTS <br />GEOTECHNICAL DATA <br />ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br />SERVING <br />San Joaquin County <br />City of Manteca <br />City of Escalon <br />City of Lodi <br />City of Tracy <br />City of Ripon <br />San Joaquin County <br />City of Steckton <br />San Joaquin County <br />Ir THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br />LOCATED AT <br />HEREBY AUTHORIZ <br />(CITY) <br />Itflaux4logr or NS <br />TO RELEASE ANY AND ALL ANALYTICAL RESULTS, GEOTECHNICAL DATA AND/OR <br />ENVIRONMENTAL/SITE ASSESSMENT INFORMATION TO THE SAN JOAOUIN 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 />(IP APPLICABLE) <br />OWNER/OPERATOR: <br />ADDRESS: <br />(NAILING 40PRESS) <br />(CITY) <br />PHONE: -070 <br />DATE: <br />EH 23 041 Revised 1/89 <br />(TITLE) <br />(STATE) (ZIP) <br />3 <br />Administration Clinical Services <br />Environmental Health Public Health Nursing <br />468.3400 468-3830 <br />468-3420 468-3660 <br />Air pollution Community Services <br />468-3470 468-3820 Laboratory WC <br />468-3280 <br />AIDS Information 468-3820 <br />