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WDA -30 OF IRUS1EES <br />Jame: Culbertson. Pres. <br />fralocis F. Vann,,r_cI, Secy <br />A,nthonelte Van Spronaen <br />Earl Plmentel <br />Fern Dughee <br />Daniel L. Flores <br />John 0. Mast, M.D. <br />vV1111am J. Weds <br />'.lery Anna Love <br />SAN JOIN LOCAL HEALTH DISTAICT46 <br />1601 Easl Hazelton Avenue, f . 0. Box 2009 <br />Slocklon, Callfornia 95201 <br />209/466-6781 <br />Jogt Khanna, M.D.. M.P_H., District Health Officer <br />AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br />f <br />SITE ASSESSMENT INFORMATION <br />I, the undersigned owner and/or operator of the property and/or facility <br />located at 935 E. Scotts Avenue, Stockton, CA 95205 <br />hereby authorize Stockton Service Station Equipment Co., Inc. <br />to release any and all analytical results, geotechnical data and site <br />assessment information to the San Joaquin Local Health District as soon, <br />as it is available and at the same time it is provided to me or my <br />representative. <br />W� <br />' F Aas Agent o S C as Receiver <br />Owned'/Operator: for Sun Savings Title: Owner <br />Address _333 S. Hope 'Street, Suite 3600 Phone: 213/687-3232 <br />Los Angeles, CA. 90071 <br />Date: June 30, 1988 <br />ENVIROMENTAL HEALTH <br />FEP.fi?I T /SERVICES <br />111 08 05 IIGT 13 <br />SERVINO <br />City of Lodi <br />San Joaquln Gounly <br />City of Escelon <br />City of Manteca <br />Cltyof Fllpon <br />City of Stockton <br />City of Tracy <br />San Joaquin County <br />San Joaquin County <br />