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t� _ <br /> BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> Ai Crow,Pres. San Joaquin County <br /> Earl Pimentel.Vice Pres 180 East Hazelton Avenue City of Manteca <br /> Tof Lo <br /> Tommy Joyce,Secy. Stockton, California 95205 <br /> 'James F.Culbertson CiCity of i. <br /> 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 .11d City of Ripon <br /> Thomas Schubert,D.V.M. ENVIRONMENTAL HEALTH D I V I S I ON,,;� .%­ s San Joaquin County <br /> Daphne Shaw (209) 468-3420 � � � City of Stockton <br /> Harvey Williams,PhD. San Joaquin County <br /> AU-Ir HC3M I Z AT I MM TO igik- <br /> -K- <br /> -K- ANALYTICAL RESULTS-'r;,'if�:':�' <br /> - - GEOTECHNICAL DATA <br /> - - ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> �C. <br /> LOCATED AT J Z q NAVY Drive, to C'k+6ti <br /> (STREET ADDRESS) (CITY) <br /> HEREBY AUTHORIZE CA1�yc'uNt, &VV1TZ0&uMCA)Tr41.. 5EAVICE Co�f�• <br /> (LABORATORY or CONSOLTANT) <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: DM s-rizoCAe, =tje- <br /> (IF APPLICABLE) <br /> OWNER/OPERATOR: F-/Z6`D L U 0 6vPK�S t DE N T <br /> (PLEAS .,PRINT) (TITLE) <br /> ��fSIGNAIUREJ <br /> ADDRESS: 02 v3 .2 'i IU Q.V r-i v E. <br /> (NAILING ADDRESS) �+ <br /> 5 f-OC.k♦o'L C� p �� D 6 <br /> (CITY) (STATE) (ZIP) <br /> PHONE: (a0l ) y 41(o OD <br /> DATE: <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 />