Laserfiche WebLink
BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT - - <br /> Al Crow,Pres. SERVING <br /> Earl Plmentak Vice Pres. 1601 East Hazelton Avenue San Joaquin Count' <br /> Tommy Joyce Secy. ity of Manteca <br /> Stockton, CaliforniaClili95205 Ci <br /> James F.Culbertson N NOV � - ry of Escalon <br /> John D.Mast,M.D. JOG) KHANNA, M.D., M,P.H., DISTRICT HEALTH OFF1t:'E 'i`i City of Lodi <br /> Virginia Mathews City of Tracy <br /> Thomas Schub aM D.V.M. ENVIRONMENTAL HEALTH D I V I S I ONr , City of Ripon <br /> Daphne Shaw San Joaquin County <br /> (20'3) 468-3420 `Ei <br /> Harvey Williams,Ph.D. ry of Stockton <br /> San Joaquin County <br /> ALJTHOFZ I ZAT I ON TO FdELEAE3E <br /> ANALYTICAL RESULTS <br /> +F GEOTECHNICAL DATA <br /> -04- ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> Ir THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OP, FACILITY <br /> LOCATED AT West Main Street Stockton, CA <br /> (Sing ADDRESS) (CITY) <br /> HEREBY AUTHORIZETice Anal (CITY) <br /> T BS lyeSL4 <br /> (LAHORAIORY oy 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: East Bay Municipal Utility District <br /> (if APPLICABLE) /� n <br /> OWNER/OPERATOR: _c„ n �a ZV,nd <br /> (PLEASE PRINT) (TITLE) l=` <br /> (SIGRA►URE) <br /> ADDRESS: 0)l West Main Street Stockton, CA <br /> (RAILING ADDRESS) <br /> (CITY) (STATE) (ZIP) <br /> PHONE: ( 209) 463-2463 <br /> DATE: August 15, 1989 <br /> EH 23 041 Revised 1/89 <br /> Administration Clinical Servicos Environmental Health Public Haalth Nursing <br /> 468.3400 468-3830 468-3420 465-3860 <br /> Air Pollution Community Services Laboratory WIC <br /> 460.3470 4118-3820 4GB-3460 468.3200 <br />