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BOARD OF TRUSTEES <br /> ON JOAQUIN LOCAL HEALTH DOR1CT SERVING <br /> Sao Joaquin County <br /> AI Grow,Pres. 1601 East Hazelton Avenue City of Manteca <br /> Earl Plmental,Vice Pres C� of Escafon <br /> Tommy Joyce,Secy. City Ca�ilornia 95205 ry <br /> City of Lodi <br /> James F.Culbertson Ci of Trac <br /> John D.Masi,M.D. JOG] KHANNA, M.D., M.P.H., DISTRICT HEALTH OFFICER iY n <br /> City of Ripon <br /> Virginia Mathews <br /> ENVIRONMENTAL HEALTH DIVISION San Joaquin County <br /> Thomas Schubert,D.V.M. <br /> City of Stockton <br /> Daphne Shaw (;l:fy) 468-3421) <br /> San Joaquin County <br /> Harvey Williams,Ph.D. <br /> AUTHOFZ T ZAT 10" TO FRE:t—FEE AeE: <br /> -*:- <br /> ANALYTICAL RESULTS <br /> - - GEOTECHNICAL DATA <br /> -re- ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> Ir THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 1245 W. Weber Avenue, Stockton, CA } <br /> {�r�p p� {CI1r1710 Main treet, EsGalon, CA 9�32C <br /> HEREBY AUTHORIZE f'WAIX InIf ulstries , Water Works Corp. , <br /> ((A10RA10RP or COxSU(TAxT) <br /> TO RELEASE ANY AND ALL ANALYTICAL RESULTS, GEOTECHNICAL DATA ANA/OR <br /> ENVIP,ONMENTAL/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: ✓1nn C <br /> (If APPLICABLE) <br /> OWNER/OPERATOR: '' LkUL)1 s ' <br /> (r E PAINT) (TITLE) <br /> - �L - <br /> (SHIATUR ) <br /> ADDRESS: PD. 1 t r <br /> (1AItIx6 ADaRE551 <br /> (CITY)) (STATE) (ZIP) <br /> PHONE: <br /> DATE: <br /> EH 23 041 Revised 1/89 <br /> /administration Clinical Services Environmental Health Public Health Nursing <br /> 468-3400 468-3830 468-9424 468-3860 <br /> Air Pollution Community Services Laboratory WIC <br /> 468.3470 468-3820 468-3460 468-3280 <br /> AIDS inlormetlon 468-3824 <br />