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a OF TRUSrEEB SA ' <br /> OU N LOCAL HEALTH DIST:- T <br /> ,ow,Pr �SERVINGes. <br /> A Plmen*vice Pray, 1601 East Hazelton Avenue am Jobot0i County <br /> ,ommy J,fa,$,0- Stookton,CalllorRla 95205 city of Marmar <br /> James F Culbertson City at 6won <br /> John D.MaA M.D. JOGI KHANNA, M,D„ MAN., DISTRICT HEAL?m OFFIb>zll Clty Of Loo <br /> Virginia Martie" Chir of Tracy <br /> i Tholn83 Schubert.DMIA ENVIRONMENTAL HEALTH DIVISIONCity of Ripon <br /> Daphne show (2010 468•-3420 Ban,Joaquin,County <br /> Norvey tMlllann,PhD. City of Stockton <br /> San JoaquIaGounty <br /> �LJTl--1df X Z^T I OM 'r0 <br /> 44- ANALYTICAL RESULTS <br /> 44% 13E0TECHN I CAL DATA <br /> OW ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> i <br /> I , THE UNDERSIGNED OWNER AND/OR• OPERATOR OF- .THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 2402 North Pacific Avenue, Stockton, California <br /> (STREET ADDR<jSS) (C1Tr) <br /> HEREBY AUTHORIZE-....fta <br /> (LA8094190 or COR;dtlAAr) _ <br /> TO RELEASE ANY AND ALL ANALYTICAL RESULTS, GEOTECHNICAL. DATA AND/OR ' <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION TO THE SAN J'OAQUIN LOCAL HEALTH <br /> DISTRICT AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED <br /> TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAMES Jim Thorpe Oil <br /> (IF APPLICAILI) <br /> OWNE CIPERATOR s z <br /> (PLUSE PAINI) (rtrLF) <br /> rS1aKAr�RF) <br /> ADDRESS: 2402 North pacific Avenue <br /> (RhUll6 ADDRESS) <br /> Stockton, Califorttie <br /> (c1Tr) (srarJ) (t1Py <br /> PHONE r368-6175 <br /> DATE: . <br /> EH 23 041 Ravi sed' i/89� � <br /> AdminloWlon Clinical Services ± <br /> Ernlronmentsl HsaJth ;� ;Fleafth Nursing <br /> 4t38.3dD0 dB8.3830 468-3420 �t3$-3860 <br /> Alr Pa�l_utlon,r. <br /> 468.347 � om4seryloft_ 633820 <br /> \ WIC <br /> AIDS Intormotl0n 488-.%1p <br />