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BOARD OF TRUSTEES SA*t JOAQUIN LOCAL HEALTH DISTTvrl�T SERVING <br /> Al Crow,Pres. San Joaquin County <br /> Earl Pimentel,Vice Pres. 1601 East Hazelton Avenue City of Manteca <br /> Tommy Joyce,Sec'y. Stockton, California 95205 City of Escalon <br /> James F.Culbertson City of Lodi <br /> John D.Mast,M.D. JOGI KHANNA, M.D., 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 (209) 468-3420 City of Stockton <br /> Harvey Williams,Ph.D. San Joaquin County <br /> AUTHC3R I Z^-r I Oh! -r C3 F;ZEILEASE <br /> - - 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 21710 MacArthur Dr. , Tracy <br /> (STREET ADDRESS) (CITY) <br /> HEREBY AUTHORIZE Balbi & Chang Associates <br /> (LABORATORY or CONSULTANT) <br /> TO RELEASE ANY AND ALL ANALYTICAL RESULTS, GEOTECHNICAL DATA AND/OR <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: <br /> (IF APPLICABLE) <br /> OWNER/OPERATOR: Dennis Flynn Agent <br /> (PLEASE PRINT) (TITLE) <br /> 0 <br /> (S16NATURE) <br /> ADDRESS: Wiggins & Assoc. , 850 West March Lane, Suite A <br /> (RAILING ADDRESS) <br /> Stockton, CA 95207 <br /> (CITY) (STATE) (ZIP) <br /> PHONE: ( 209 ) / 943-6408 <br /> DATE: 12/05/90 <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 />