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1111040110 OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> N Crow.Pres. Sen Joaquin County <br /> EM PtrnrleL Vice Pres. 1601 East Hazelton Avenue City of Manteca <br /> Tarns JoyCe.Secy. Stockton, California 95205 City of Eecalon <br /> James F.Culbertson city of Lodi <br /> Jam 0.Most M.O. JOGI KHANNA, M.D., M.P.H., DISTRICT HEALTH OFFICER City of Tracy <br /> vk*ja Mathews City of Ripon <br /> Thornes Schubert o.VJA ENVIRONMENTAL HEALTH DIVISION San Joaquin County <br /> 0evlme Show (209) 468-3420 City of Stockton <br /> Hervey VM"im PhD. Sen Joaquin County <br /> ^U-rHOFt I ZAT I ON TO REL—EA8t_ <br /> +a ANALYTICAL RESULTS <br /> -1001- GEOTECHNICAL DATA <br /> -00- ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I , THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 9901 Woodward Road, Ripon, CA <br /> (SlNEEf AIIAESS) (blip) <br /> HEREBY AUTHORIZE CannniP Fnvironmpntal . Stockton , CA 983-1340 <br /> (LAIOAAIIII 4t CONSIl1ANf) <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 NAMEt K 13 I .S <br /> (IF ANLICNLE) <br /> OWNER/OPERATOR: in A 2.G 1' 21,1�7- V S S &�J—L Q 6tir A) it �? <br /> (PLEASE pill!) (711U) <br /> -W a'i , &J <br /> (S1A r1AE) <br /> ADDRESS: P-U W('-Xr L4,9 '7 <br /> (IAil1Ni AIRES$) <br /> )I1&-& GA- 6?$36 <br /> (till) (SIME) (lip) <br /> PHONES ( > <br /> DATEr /lq qq <br /> EH 23 041 Revised 1/89 <br /> Administration Clinical Services ErwimmenW Health Public Health Nursln0 <br /> 4611.3400 485.3&90 488-3420 468-3880 <br /> Air PoNulbn CamwmKy Services Leborelory VMC <br /> 483.3470 468-3820 468-3480 468.3280 <br /> NDS trlarrts8on 468.3110 <br />