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• BOARD OF TRUSTEES JOAQUIN LOCAL HEALTH DIS T <br /> Al Crow,Pres, SERVING <br /> Earl Pimentel,vice Pres. 1601 East Hazelton Avenue San Joaquin County <br /> Tommy Joyce,Secy. Stockton, California 95205 City of Manteca <br /> James F.Culbertson City of Escalon <br /> John D.Mast,M.D. JOGI KHANNA, M.D., M.i?H., DISTRICT HEALTH OFFICER City of Lodi <br /> Virginia Mathews City of Tracy <br /> Thomas Schubert,D.V.M, ENVIRONMENTAL HEALTH DIVISION City of Ripon <br /> Daphne Shaw _ San Joaquin County <br /> Harvey Williams,Ph.D. <br /> (209) 468-3420 S �+�s'rt-) City of Stockton <br /> San Joaquin County <br /> ^u-r"OFR I z^-r I G71V TCM �:EL�A3iE <br /> - <br /> ANALYTICAL RESULTS V ' <br /> - - GEOTECHNICAL DATA <br /> J u N 2 1 1990 <br /> -w- ENVIRONMENTAL/SITE ASSESSMENT I NF"ORMATFI ``-- <br /> ��iVMENTAL <br /> M111911 I-,. <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED Ar -7%S c�_�:--�— <br /> "C �a I...t.. CIA- <br /> (STREET ADDRESS) (CITY) <br /> HEREBY AUTHORIZE <br /> (LABORATORY or CONSULTANT) <br /> TO RELEASE ANY AND ALL ANALYTICAL RESULTS, GEOTECHNICAL DATA ANA/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: /'- 0 / 7'C, / J <br /> �� (IF APPLICABLE) <br /> OWNER/OPERATOR: /p /y ( J <br /> (PLEASE PRINT) (TITLE) <br /> (ST6NATURE) <br /> ADDRESS:._ <br /> (NAILING ADDRESS) <br /> (CITY) (STATE) (ZIP) <br /> PHONE: E _ J,/�, Co <br /> DATE: <br /> EH 22 041 RPv15/ed 1/89 <br /> Administration Clinical Services Environmental Health Public Health Nursing <br /> 468-3444 468-3830 468-3420 468-3860 <br /> Air Pollution Community Services Laboratory WIC <br /> 468-3474 468-3820 468-3460 <br /> 468-3280 <br /> AIDS Informallon 46R-3R?0 <br />