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r <br /> SAA! JOAQUIN LOCAL. HEALTH DISTRICT CERVINO <br /> Will OF IrRUBTEES Ban Joaquin County <br /> Al Crow.POL 11601 East HazaltonAvenue City 01Menleca <br /> on <br /> Earl Pinrenlel,%lea P16L 5tacklon,camornla 95205 City of a oty of <br /> r-mmy Joyce,800f LCodi <br /> ae l�on City of TrEey <br /> F.Culber <br /> Ivan 1S,Mast M.D. JDPI KNANHA, M.D., M,P.rI.,DISTRICT HEALTH OFFICER � C!y at Ripon <br /> Virpinlo Mofhews son Joapin Count' <br /> 1 homaa Sehubart o Y.M. ENVIRONMENTAL HEALTH D I V I B I ON City of Stockton <br /> paphneSchu t209I '4613-3420 Ban Joaquin County <br /> how <br /> elarvey VAIIIRme,Phb. -r o R M L—M A S E <br /> LJ'1'1-13 Y Z. T Y !�h! <br /> •+tae- ANALYTICAL RESULTS <br /> •e,• GEOTECHNICAL DATA <br /> •aa• ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> 1, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 2 <br /> (SrAEEt Atilt$9 (011) <br /> HEREBY AUTHORIZE—ME <br /> gLAIOAAroR7 or COASIfrAN) I <br /> ROW <br /> TO RELEASE ANY AND ALL ANALYTICAL RESULTS, GEOTECHNICAL DATA AND/OR <br /> ENVIRONMENTAL/BITE ASSESSMENT INFORMATION TO THE SAN JOAQUIN LOCAL. HEALTH <br /> DISTRICT AS SOON AS 1T IS AVA LADLE AND AT THE SAME TIME IT 19 PI•tDVIDED <br /> r�:ME DR MY REPRESENTATIVE. <br /> BUSINESS NAME11 (Il APPiICABIE) <br /> r � <br /> OWNER/CPERATOPI (PiEASE (Tfl[i) <br /> es AE) <br /> ' ADDRES91 ,L' <br /> (politic o11IESS) <br /> Q •z. <br /> (6(if) r7 (STAID flit) <br /> PHONEtlq6.� <br /> i ] Q <br /> DATEir <br /> E, 13 041 Re•vf Sed 1/89 <br /> �• Cffnfcsl Servleaa l:nvtronmenfat 11ra1ff+ Pubil41ioa11h"killing <br /> Adminfetraffon 169,3420 4611-3660 <br /> 496•34f>0 199.3930 <br /> Uboralo who <br /> Alf Peftwon CommServices_ _ _ 7 _ 406.3280 - <br /> 466.3470 496.305.3 620 408-3400 <br /> AIDS Informallon 469-3820 <br />