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BOARD OF TRUSTEES **AN JOAQUIN LOCAL HEALTH Dri RICT SERVING <br /> Al Crow,Pres. San Joaquin County <br /> Earl Pimontel,Vica Pres. 1601 East Hazelton Avenue City of Manteca <br /> Tommy Joyce,Secy. Stockton, California 95205 City of Escalon <br /> James F.Culbertson City of Lodi <br /> John D.Mast,M.D. JOGI KHANNA, M.O.. M.P.H., DISTRICT HEALTH OFFICER City of Tracy <br /> Virginia Mathews City of Ripon <br /> Thom"Schubert D.Y.M. ENVIRONMENTAL HEALTH DIVISION San Joaquin County <br /> Daphne Shaw (209) 468-3420 City o1 Stockton <br /> Haney Williams,Ph.D. <br /> San Joaquin County <br /> AU-r"C3 I ZAT I ON TO REt_EABE <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 Cat len S, f-,LAA,1 g-c A, }, r A,_ Q -3 <br /> ($71EE1 A109ESS) (CIIYI <br /> HEREBY AUTHORIZE C��O�btUAt-c -iG � LrigQ� <br /> (tA80"foxy Of, CONSul1A11) <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: L*�1 Pt rr FP. <br /> (if J"LICAJIIE) <br /> OWNER/OPERATOR: N A _ <br /> (IL fill) (IIIIE) <br /> (S16NAlUAE) <br /> ADDRESS: <br /> (IAll1N6 AlOtf551 - -- <br /> rn �- CA �t533C� <br /> rerrn (S/410 <br /> PHONE: <br /> DATE: 2- :37-,q v <br /> EH 23 041 Revised 1/89 <br /> Administration CJlnlcaf Senicos Envlronmenlal Haatlh Public Health Nursing <br /> 468-3400 468-3830 468-3420 468-3860 <br /> Air Pollution Community Services Laboratory WIC <br /> 460-3470 468-3820 468-3460 468-3280 <br />