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UB C HEALTH SERVICEu. <br /> S <br /> :4 •M. <br /> T <br /> 25 SAN JOAQUIN COUNTY <br /> DC. 3 <br /> X <br /> JOG[KHANNA MR,M.P.H. <br /> Health Officer <br /> '"' <br /> P.O. Box 2009 • (1601 East Hazelton Avenue) St.Ckton,Califurnia 932.01 610 % <br /> F4i 7 <br /> W, F <br /> (209) 468.3400 <br /> DEC 7 S 8 Rt <br /> ENVIRONMENTAL HEALTH DIVISION <br /> ENVIRONmENTAL F` <br /> (209) 468-3420 i <br /> I I PERM IT/StERV�'�­_� <br /> AU-rFACD R X z AT x am T© m E=-L_1-=A r=-F-= <br /> 41- LYT-,ICAU-RESULTS <br /> GEOTECHNICAL DATA <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> 1603 .South B Street, Stockton. CA! Caltrans <br /> LOCATED AT <br /> (STREET ADDRESS) <br /> (CITY) <br /> HEREBY AUTHORIZE' <br /> (LABORATORY ak- CONSUL TAN T) <br /> TO RELEASE ANY AND ALL ANALYTICAL RESULTS., GEOIECHiNICAL DATA AND/Ok- <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION TO SAN JOAQUIN COUNTY PUgLIC <br /> HEALTH SERVICES AS SOON AS IT IS AVAILABLE AND! AT THE SAME TIME IT IS <br /> PROVIDED TO ME OR MY REPRESENTATIVE. <br /> BUSINESS .NAME: Department .6f Transportation Caltrans Equipment Shop 10 <br /> -IF AP_PL-1CABLE)—,," <br /> UFST Coord <br /> OWNER/OPERATOR: —" 'Caltrann State DeR-'----' tment of Trans ortation <br /> !-'LEASE P15RI7 A I f TI TLE) <br /> (SIGNATURE) <br /> P.O. Box 2048 , <br /> ADDRESS: <br /> (NAILING ADDRESS) <br /> Stockton, CA 95201 <br /> sf <br /> (CITY) i (STATE) (ZIP) <br /> PHONE: 209 948-7406 <br /> A <br /> �p4 <br /> December 4 . 1989 <br /> DATE: <br /> EH 23 041 Revised 10/89 <br /> A Division of San Joaquin Counry Health Care�Iliry ire% <br />