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s <br /> 0 BOARD OP TAttgn= SAN J OAQUIN LAICAL HEALTH DISTRICT <br /> In Crow,Prce SENVIf1G <br /> Earl Pkm"K Vlea Prsa. 1ti01 F.ssl h(BYOItOfI Avenue Sao Joaquin County <br /> To 3ay�,�'y Stockton,Callfomia 95205 Gry of �' ' <br /> innn OF Cub~ City of Eeoalon <br /> John 0. ,6f. <br /> JOOI KHANNAD.,MPJ4 OWMICT MEALTH OFftEn Gty of L01 <br /> mathmMy of Tracy <br /> ® Dash"Sahabut D.V.K ENVIRONMENTAL HEALTH DIVISION City of Rpm <br /> BMW (209) 468-3420 San JoagW,n County . <br /> H"wulfam%PhD. Gly of Stockton <br /> San Joaquin County <br /> ^U-rHMM X ZIOIT a OIC -rO ReL— ;/ eEL- <br /> -PP ANALYTICAL RESULTS <br /> GEOTECHNICAL DATA <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> 4 ® Ir THE-UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> "i LOCATED AT 800 FEttlff m I.-m, Ibdi, t l� <br /> (STditt ADDSESS) (City) E <br /> HEREBY AUTHORIZE,„ <br /> (tAe0141017 ap CoasIL1.41 i - <br /> 450 TO RELEASE ANY AND ALL ANALYTICAL RESULTS„ GEOTECHNICAL DATA AND/OR <br /> r.. <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 /> k ME OR MY REPRESENTATIVE <br /> rs BUSINESS. NAME) PRD PraIr s CbTPW <br /> (IF Afflt0JLf) <br /> OWNER/OPERATOR: xYde Chdstie <br /> awircmatal mxfirfEr <br /> r <br /> (PIEJSf ffff1) (t11tf) <br /> >r� <br /> f 01610180 <br /> ® ADDRESSs P.O. Bit 5813 <br /> (KA1t1ff AQ6tfSS) <br /> cla <br /> Aw piLVa <br /> LpU <br /> (CM1 - ` <br /> ($141f) (46V) <br /> ® PHONE: f 415 ) 571-2434 - <br /> 6` <br /> DATES D-,aad:c-r 17, 1990 _ <br /> 4 EH23 041 Revised 1/89 <br /> i Adminlstrstlon C1Gtical Banloe¢ Otviranmanw Health <br /> Er ! 48M3i00 <br /> 488.3030 b1i4 Hoaffh NuratnQ <br /> 460.3120 <br /> A!rAollutlat Cs 3arrlceg -r—#- 480.386@ # <br /> ® 408.3470 488•:1020 A�0,.'{460 <br /> WIC <br /> AIDS Infonnak t 468.3M } <br /> , <br /> xS <br />