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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> Al Crow,Pres. <br /> Ear!Pimentel,vice Pres. 1 601 East Hazelton Avenue San Joaquin CountyCity of Manteca <br /> Tommy Joyce,Sec'y. Stockton,California 95205 City of Escalon <br /> James F.Culbertson <br /> City of Lodi <br /> John D.Mast,M.D. JOGI KHANNA, M.D., MIP.H., DISTRICT HEALTH OFFICER City of Tracy <br /> Virginia Mathews City of Ripon <br /> Thomas Schubert,D.V.M. ENVIRONMENTAL HEALTH DIVISION San Joaquin County <br /> Daphne Shaw (20 9) 46$-3420 City of Stockton <br /> Harvey Williams,Ph.D. San Joaquin County <br /> AU-r"(:)F;Z I ZAT I OM -rM F-:EI_EA0E <br /> -�- ANALYICAL RESULTS <br /> - - GEOT CHNICAL DATA <br /> - - ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR: OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 2120 Wi 1 cox Road Stockton, CA. <br /> (STREET ADDRESS) (CITY) <br /> HEREBY AUTHORIZE F.G.L. <br /> (LABORATORY or CONSULTANT) <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: Moorman's Water systems <br /> (1F APPLICABLE) <br /> OWNER/OrERATOR: Larry Moorman President <br /> (PLEASE PRIN (TITLE) <br /> l SISJIRT UAE) <br /> ADDRESS: 2120 Wilcox Road <br /> (NA1LIN6 ADDRESS) <br /> Stockton Ca. 95205 <br /> (CITY) (STATE) (IIP) <br /> PHONE: ( 209 ) 931-3210 <br /> DATE: Feb. 7, 1990 <br /> EH 23 041 Revised 1/09 <br /> Administration Clinical Services Environmental H90h Public Health Nursing <br /> 468-3400 468-3830 468-3420 463-3860 <br /> Air Pollution Community Services Laboratory WIC <br /> 468-3470 468-3820 468-3460 468-3280 <br /> AIDS Information 465-3820 <br />