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/ PUBLIC HEALTH SERVICES .�....N. <br /> SAN JOAQUIN COUNTY <br /> {� JOGI KHANNA M.D.,M.P.H. <br /> Health Officer <br /> AO. Box 2009 . (1601 East Hazelton Avenue) . Stockton,California 95201 <br /> (209)468-3400 <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209) 468-3420 <br /> FIUTHCfFR I ZAT I M" T© FR M6=iSE <br /> ANALYTICAL RESULTS <br /> GEOTECHNICAL DATA <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> X, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FAC•IL1rY <br /> LOCATED AT 141 North EI Dorado Street Stockton <br /> (STREET ADDRESS) (CITY) <br /> HEREBY AUTHORIZE Leedshill-Herkenhoff, Inc. <br /> (LABORATORY or, CONSUL TANT) <br /> � TO RELEASE ANY AND ALL ANALYTICAL RESULTS, GEOTECHNICAL DATA AND/OR- <br /> , <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION TO SAN JOAUUIN COUNTY PUBLIC <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: C.M. Weber .Enterprises <br /> (IF APPLICABLE) <br /> OWNER/OPERATOR: Gerry Nakano- Consultant <br /> (PLEASE PRINT) [TITLE) <br /> (SIGNA TURF) <br /> ADDRESS: 303 Second Street, Suite 88ON <br /> (MAILING ADDRESS) <br /> San Francisco California 94109 <br /> (CITY) (STATE) (ZIP) <br /> PHONE: 1 ( 415 ) 243-9980 <br /> DATE: <br /> EH 23 041 Revised 10/89 <br /> A Division of San Joliquin Counry Heath Corr Cervices <br />