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x <br /> Cb BOARD OF T1{1lMM SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> At Crate,Pm 3ERYIfiG <br /> rAffpkwftVw0pM 1601 F-831 Hazelton Avenue San Joaquin county <br /> Toma+yJayas.seat'. <br /> Jtsraaa F.� Stockton,Callf4rnia 95205 City of Manteca <br /> City o3 n <br /> John 4 Mast,M.D. J001 KNANt�IA,111.0., &LPJ4 DWMICT MULTH OFFIt:6n City of Lodi <br /> ew4fli t Ma"" Cyvf Tracy <br /> .u4f. �8ftw OV ENVIRONMENTAL HEALTH DIVISION CRY ofFU;xm <br /> "&VEY YYllpanuh Pft.D (209) 468-34-20 San Joaquin County <br /> City of Stochtan <br /> San Joaquin County <br /> T-O FELIi�aQ►SE <br /> -�- ANALYTICAL RESULTS <br /> -sM GEOTECHNICAL DATA <br /> w ENVIRONMENTAL/SITE ASSES <br /> 511ENT INFORMATION <br /> H I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF' THE PROPERTY AND/13R (AGILITY <br /> r <br /> LOCATED AT 1612 Hmm.-Imo, St xk=, Gili.fania: <br /> (Sli ffl.Ad M7; (Cllr} <br /> € HEREBY AUTHORIZE <br /> f11D0tUQRf ar COdSB1fANr} <br /> tO TO RELEASE ANY AND ALL ANALYTICAL RESULTS, GEOTECHNICAL DATA ASVD/OR <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION TO THE SAN JOAQUIN <br /> ` LOCAL HEALTH - <br /> DISTRICT AS. ,SOON AS IT I5 AVAILABLE AND AT THE SAME TIME IT IS PROVIDED <br /> se) ME OR MY. REPRESENTATIVE. <br /> BUSINESS NAMZ: AFM>Pnxbcts Qztpmiy � <br /> ,,, ,. � (IF API1rCIDlE1 <br /> OWNER/OPERATOR: k <br /> 01WE A;INO (fiflfl <br /> (S18N4f1lRE} i <br /> ADDRESS: PA. I3x 5811 <br /> � �: (NAlildG AddtfSSJ _. ; <br /> { <br /> SEn t$lo, Cal i farm-=+ 94402 <br /> rsr,�rF} (tlJy <br /> PHONE: ( <br /> 4t7y -511-2434,:' <br /> DATE: 17,1990 <br /> Eli 23 041 Rev(.sed 1/89 <br /> � ` `� Adminisorst3art _ <br /> r CilNCai 3erri�o <br /> t 468. 00 6rt►iranmanfal Heatus <br /> _ 46a-3= 46a•34runlia Hoalth Nursing <br /> Air Po it do.�.:_ 489-3950 <br /> 48x•3470' Community Servicesry <br /> :. 46a-aa20 LabOrat6WIC <br /> 40a-Nco 4ox-3290 <br /> i AIDS Intormadon 483-3820 <br /> i <br />