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- w• <br /> Mai <br /> MAN <br /> - 3 <br /> OARD OF IRUBTEES SAN JOAQUIN LOCAs. HEALTH (DISTRICT 13Er�vINCi <br /> At Crow,Pre&, San Joaquin County <br /> Earl Plmenirtl,Vice Pres, 1601 East Hezeilon Avenue <br /> City of Memece <br /> mmy Joyce.SeC'y. Stockton,California 95205 Cllr of Escalon <br /> ,nes F.Culbortson City of Lod{ <br /> f.. John 0.Mast,M.D. JOG( KHANNA, M.D.. M.P.M. DISTRICT HEALTH OFFICER City of Tracy <br /> Virginia Mathews City or Ripon <br /> Thomas Schubert,C.V.M. ENVIRONMENTAL HEALTH DIVISION Sen Joaquin County <br /> Daphne Shaw (209) •465-3420 City of Stockton <br /> Harvey Wllllems,PhD. San Joaquin County <br /> ^6:._.1T1--1OR a Z^`r I E31\111 TO PZZML.CA8II_ <br /> - ANALYTICAL RESULTS <br /> -*� GEOTECHNICAL DATA <br /> 44- ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR Or THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 2Z5 E, GRAM LINE ROAD TRACY, -_ CA, �J�3Jfi <br /> (S1AIE1 ADDRESS) _ (City) .!_ <br /> HEREBY AUTHORIZE (GIEL) MUMER TECHNOLOGY M1BQRML LABEMRY <br /> ([AAQAA W at CDNSOLIANO <br /> TO RELEASE ANY AND ALL ANALYTICAL RESULTS, GEOTECHNICAL DATA tND/OR <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION TO THE SAN JOAQUIN LOCAL HEALTH <br /> "�9TRICT AS SOON AS IT IS AVAILAPLE AND AT THE SAME TIME IT I3 PROVIDED <br /> TO ME OR MY REPRESENTATIVE. <br /> I r tiC <br /> BUSINESS NAMEScr <br /> (If AWICAA[F) <br /> DIdNER/t]PERATORSy— <br /> y(i{SSE l t 11 iEJ <br /> (5 AF) <br /> ADDRESS <br /> CA— <br /> rsrrrJ Gl 4 Z. 44._x_.• _ <br /> ,q. (SIA11) flit) <br /> PHONES � <br /> DATES Dy.: l I q6Q <br /> f <br /> i_,-23 041 Reil sed 1/89:1 . <br /> Administration Clinical Servicos Environmental flaatlh Public Hoelih Nursing <br /> 400-3400 488.9890 <br /> 466•3420 A88 9880 <br /> Ar Pollution Community Services Lnboratory <br /> 488.9470 488.3820 408.3400 yyig <br /> 408.IC <br /> AIDS lnformatlon 468.9826 <br />