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/AJ <br /> OARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICTSERVING <br /> Crow, Pro&rl Plmental, Vice Pres. 1601 East Hazelton Avenue sen Joaquin County <br /> mmy Joyce, sec°y Stockton, California 95205Gry of Manteca <br /> mes F. Culbertson City a Escalon <br /> hn D, Mast M.D. JOOI KHAN Gty of Lodi <br /> NA, M.O., ►/A.H., DISTRICT HEALTH OFFICER0lnla Mathew& City of Tracy <br /> Ripon <br /> Thomas Schubert D.V.M_ ENVIRONMENTAL HEALTH DIVISION SCity aan Joaquin County County <br /> Daphne Shaw ( 209 ) 468 - 3420 <br /> Harroy Wlllism&, PRD. City a Stockton <br /> Sen Joaquin Count' <br /> AUTNiN7Fit I ZAT I ON TO RELEASE <br /> ANALYTICAL RESULTS <br /> i+ GEOTECHNICAL DATA <br /> et ENVIRONMENTAL / SITE ASSESSMENT INFORMATION <br /> It' THE UNDERSIGNED OWNER AND / OR OPERATOR OF THE PROPERTY AND / OP, FACILITY <br /> LOCATED AT _ `� 3� INCST �� rt2rc�e In /n l STc�/cTo <br /> lS1AEE1 AAANESS) (Cllr) <br /> HEREBY AUTHORIZE__ FC:1 _ <br /> ( LASOAAIOAT or CONSILIAII ) <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 /> i <br /> h BUSINESS NAMES /V� I �+ <br /> D M E I,L I rV I r1�n-1 �T,�-tt cT/ OnJ LSU <br /> (if OPLICAIU) <br /> OWNER / OPERATOR ( SAJ ^J \l S41i9WAS )-{ PA� 2� Mq ^Ja6� <br /> (IL[d PNU►) (11 Eft <br /> (Sl6NA/UNE) <br /> AQ . <br /> ADDRESSS <br /> (IJIL116 AIDI0V <br /> (City) rsfAlE) rlU) <br /> PHONES ( SO4) ) 4[= <br /> DATES 41x0 . 89 <br /> EH 23 041 Revised 1 / 89 <br /> Administration Clinical Senicas Environmental Health Public Hoalth NursIng <br /> 468-3400 468-9890 468-9420 <br /> 466-3660 <br /> Air Pollution Community Services Laboratory <br /> 488.3470 486- 3820 40B_3gONIC <br /> 468 -1260 <br />