Laserfiche WebLink
9GAAD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> At Crow,Pres, i, San Joaquin County <br /> Earl Pimento[.Vice 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.D., M.P.N., DtSTRICT 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 (2Q9) 468-3420 City of Stockton <br /> Harvey Williams,Ph.D. San Joaquin County <br /> AUT"©F;Z I ZAT I C r%J TCA F;ZEL.EAE3E <br /> -�- ANALYTICAL RESULTS <br /> Ei <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 im Stockton CA <br /> (STRICT ADDRESS) jj (CITY) <br /> HEREBY AUTHORIZE Canonie Environmental , Stockton., CA 983=1340 <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 /> BUS I NESS NAME "O-ze « 9�F <br /> (IF APPLICABLE) <br /> OWNER/OPERATOR: <br /> (PL ASE PRINT) (TITLE) <br /> (SI6NAIU ) <br /> ADDRESS: /�7 /3dJC 3-8 9 <br /> (RAILIN& ADDRESS) <br /> 9/'0' <br /> (CITY) (STATE) flip) <br /> PHONE: (Z-0'7 <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 />