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`^f3*AAD OF. TAISTEE8 SO JOAQUIN LOCAL HEALTH DACT SERVING <br /> AI Crow.Pres, San Joaquin County <br /> Fad Plmentel.Vico Pres, 1601 East Hazelton Avenue City of Manteca <br /> Tommy Joyce.Sec'y. Stockton,California 95205 City of Eacalon <br /> James F.Culbertson City of Lodi <br /> John D.Most M.D. J061 KHANNA, M.D., M.P.II., DIStnICT HEALTH OVFICEn City of Trocy <br /> Vlrpinla Mathews City of Npon <br /> Thomas Schubert,D.V.M. ENVIRONMENTAL HEALTI4 DIVISION Son Joaquin County <br /> Daphne Shaw _ (!09) 468-3420 city of5ixkwn <br /> Harvey Williams,Ph.D. San Josauin County <br /> A0_A`r1-iOK I Zoe%. , X Ot%J 11-0 RIES;L-E-EA23E <br /> +« ANALYTICAL, RESULTS <br /> at- GEOTECHNICAL DATA <br /> 4"h <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I1 THE UNDERSIGNED OWNER AND/OR OPEZRATOR OF THE PPOPE: Y AND/OR FACILITY <br /> LOCATED AT ZITS Q$ � 4fC 164 SF• <br /> (sr EEt ac Dss) <br /> HEREBY AUTHORIZE_�-t'_M I Q _ )afe r L a _.- <br /> (LABOAATOAy or (00satIANT) <br /> TO RELEASE ANY AND ALL ANALYTICAL RESULTS, GEOTECHNICAL DATA AND/OR' <br /> ENVIRONPEENTAL/SITE ASSESSMENT INFOt�MATION TO 'THE SAN JOAQUIN LOCAL HEAL1-14 <br /> DISTRICT AS SOON AS IT IS AVAILAPLE AND AT' THE SAME TIME IT IS PROVIDED <br /> TO ME OR MY REPRESENTATIVE. <br /> -- '—.�_ <br /> BUSINESS NAMEt_ t'1 1 /j C_ 1 r!OIQSs�s (f0 • <br /> (IT AttLICABLE) <br /> OW14ER/OPERATOR: / K� - � 7PF�wler / taro � <br /> ltIEASC tRIMf (TITLE) <br /> ADDRESS: <br /> (NAIL 6 <br /> Of GC/ /Jp <br /> (Cirri (STATE))-' (I 1r) <br /> L o z � Z <br /> LDATEI . <br /> EH 23 041 ReVlaed 1/133 <br /> Adminlstralloo Clinical S.eivicoa Environmental ileaith Pubic Health Nursing <br /> 4C,8.3400 460-3830 460.3420 468.3660 <br /> Air Pollution Community 84Mces t boratoty "c- <br /> 468-3470 468.3620 468-3400 408.92up <br /> AIDS Information 468.9820 <br />