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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING ` <br /> Al Crow,Pres 1601 East Hazelton Avenue San Joaquin County <br /> Earl Pimentel,Vice Pres. City of Manteca <br /> Tommy Joyce,Secy. Stockton, California 95205 _ City of Esoalon <br /> James F.Culbertson City of Lodi <br /> John 0.Mast M.D. JOGI KHANNA, M.O.. M.P.H., DISTRICT HEALTH OFFICER City of Tracy <br /> Virginia Mathews City of Ripon <br /> Thomas Schubert D.V.M. ENVIRONMENTAL HEALTH DIVISION San Joaquin County <br /> Daphne Shaw (203) 468-3420 City of Stockton <br /> Harvey Williams,Ph.D. San Joaquin County <br /> AUTHOR I ZAT I ON TO RE!_FEE ASIE <br /> -x- ANALYTICAL RESULTS <br /> - - GEOTECHNICAL DATA <br /> - - ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT Jr 4'71 F x9taeRt <br /> (STREET ADDRES ) (CITY) <br /> HEREBY AUTHORIZE ,�� iv�ilrl <br /> (LABORATORY or CONSULTANT) <br /> TO RELEASE ANY AND ALL ANALYTICAL RESULTS, GEOTECHNICAL DATA -AND/OP. <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: MOORE PETROLEUM <br /> (IF APPLICABLE) <br /> OWNER./OPERATOR: JERRY MOORE PRESIDENT <br /> l ASE PRINT) (TITLE) <br /> ADDRESS: P . O . BOX 67 <br /> 41LIN6 ADDRESS) <br /> BANTA CA 95304 _ <br /> (CITY) (STATE) (ZIP) <br /> PHONE: ( 209 ) 835- 2750 <br /> DATE: 2- 24-89 <br /> EH 23 041 Revised 1/89 <br /> Administration Clinical Services Environmental Health Public Health Nursing <br /> 468-3400 468-3830 468-3420 468-3860 <br /> Air Pollution Community Services Laboratory WIC <br /> 468-3470 468-3820 468-3460 468-3280 <br /> AIDS Information 468-3820 <br />