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4' BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br />AI Crow, Pres. <br />San Joaquin County <br />Earl Pimentel, Vice Pres. <br />1601 East Hazelton Avenue <br />City of Manteca <br />Tommy Joyce, Secy. <br />Stockton, Calilornia 95205 <br />City of Escalon <br />James F. Culbertson <br />City of Lodi <br />John D. Most, M.D. <br />JOGI KHANNA, M.D., M.P.H., DISTRICT HEALTH OFFICER <br />City of Tracy <br />Virginia Mathews <br />City of Ripon <br />Thomas Schubert, D.V.M. <br />ENVIRONMENTAL HEALTH DIVISION <br />San Joaquin County <br />Daphne Shaw <br />( 209) 465-3420 <br />City of Stockton <br />Harvey Williams. Ph.D. <br />San Joaquin County <br />AUTHOR I ZAT' I C]h! TO lZEILEA!3E <br />-K- ANALYTICAL RESULTS <br />-114- GEOTECHNICAL DATA <br />-w ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br />I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTYIAND/OR FACILITY <br />LOCATED AT 1725 SanguineLti l.n. Stockton, Ca. <br />(STREET ADDRESS) (CITY) <br />HEREBY AUTHORIZE Calif. Water Lab., Carpenter Rd.,Modesto,Ca. <br />(LABORATDRY or CDRSKIARTI <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: CHANNEL MECHANICAL <br />(IF APPLICABLE) <br />OWNER/OPERATOR:rz;i 0, C �- <br />(PEEArPm?) /, / (TITLE) <br />(SIGNATURE) <br />ADDRESS: 1725 Sangt_linetti Ln. <br />0AILIR6 ADDRESS) <br />Stockton, CA. 95205 <br />(CITY) <br />PHONE-. (2 09 7 tr F j 5 91 <br />DATE: <br />EH 23 041 Revised 1/89 <br />(STATE) (ZIP) <br />Administretlon Clinical Services Environmental Health <br />468-3400 468-3830 468-3420 <br />Air Pollution Community Services Laboratory <br />486-3470 468-3820 468-3460 <br />AIDS Information 468-3820 <br />Public Health Nursing <br />468-3860 <br />WIC <br />468-3280 <br />