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BOARD OF TRUSTEES SW JOAQUIN LOCAL HEALTH DISwTRvICT <br />Al Crow, Pres. <br />Earl Pimenlel, Vice Pres. 1601 East Hazelton Avenue <br />Tommy Joyce, sawn, <br />James F. Culbertson, Stockton, California 95205 <br />John D, Mast, M.D. JOGI KHANNA, M.D., Y.RH, DISTRICT HEALTH OFFICER <br />Virginia Mathews <br />Thomas Schubert, D.V.M. ENVIRONMENTAL HEALTH DIVISION <br />Daphne Shaw (20 3) 468--3420 <br />Harney Williams, Ph.D. <br />AU-r"01R Z ZAT' Y ON <br />TO 1;ZEL-EA0E: <br />#+- ANALYTICAL RESULTS <br />'m GEOTECHNICAL DATA <br />-14- ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br />SERVING <br />San Joaquin County <br />City of Manteca <br />City of Escaton <br />City of Lodi <br />City of Tracy <br />City of Ripon <br />San Joaquin County <br />City of Stockton <br />San Joaquin County <br />I, THE UNDER IGNED OWNER AND/OR OPERATOR OF THE PROPERTY AVP/OR FACILITY <br />LOCATED A <br />191orri, lhherer� <br />HEREBY AUTHOR I ZE ---.EO rcrrl� i <br />(LASORA101Y 4P <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 />OWNER/OPERATOR: <br />ADDRESS: <br />(!F 4PPOCAIL0 <br />.L�' <br />("ILI11 <br />O <br />(ClTl)pfSlA1I1 / (III) <br />PHONE: (' I 17T r ��" 0 6 <br />DATE: ��,� � � /} <br />d 14'O 1 1989 <br />EH 23 041 Revised 1/89 FNVip16 <br />f�Pv,"q"AL HEALTiH <br />Administration Clinical Services EnvironmentalHealth Public Hea <br />468.3400 468-3830 60 <br />Public Health Nursing <br />_ 468-3420 468-38 <br />Air ion Community SerL <br />4688-x4-34 70 466-3M 458-3460 <br />Laboratory VYIC <br />468-3480 468-3280 <br />AIDS Information 46a -3M <br />