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BOARD OF TRUSTEES DISTRICT SERVING <br /> Al Crow,Pres. San Joaquin County <br /> Earl Pimentel,vice Pres. *Vol 1601 East Hazellon Avenue NWM04 G City of Manteca <br /> Tommy Joyce,Sec'y. Stockton, California 95205 City of Escalon <br /> ;fames F,Culbertson City of Lodi <br /> John D,Mast,M.D. JOGI KHANNA, M.O., M.P.H., DISTRICT HEALTH OFFICER Cly of Tracy <br /> Virginia Mathews City of Ripon <br /> Thomas Schubert,D.V.M. ENVIRONMENTAL HEALTH DIVISION San Joaquin County <br /> Daphne Show (209) 468-3420 City of Stockton <br /> Harvey Williams,Ph.D. San Joaquin County <br /> AUTHOFZ I Z AT I M -117 C3 RELEASE <br /> - - ANALYTICAL RESULTS <br /> -he- GEOTECHNICAL DATA <br /> -+- ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> PRIOR <br /> I , THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACI'L�,TY <br /> LOCATED AT <br /> (STREET ADDRESS) (01Y) <br /> HEREBY AUTHORIZE BE I ARSIWATFRWt7RK <br /> ILAEORArORY or CONSULTANN <br /> TO RELEASE ANY AND ALL ANALYTICAL RESULTS, GEOTECHNICAL DATA ANWOR <br /> ENVXRONMENTAL/SITE ASSI7SSMENT INFORMATION TO THE SAN JOAQUIN LOCAL HEALTH <br /> DISTRICT AS SOON AS 17' IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED <br /> TO ME OR MY REPRESENTATIVE, <br /> BUSINESS NAME t MRF& MRs, HARRY LORZ/DBA LOD I CONCRETE PIPE <br /> (if APPirCABLEI <br /> OWNER/OPERATOR: HARRY & INGE LORZ <br /> (PI,EASf PRIND. J <br /> (TIT ! <br /> (SISrf�l RE) <br /> ADDRESS: 17320 VALL ULEVARD <br /> INAI(116 ADDRESS) <br /> JACKSON, CALIFORNIA 95642 <br /> (CITY) (STATE) (10) <br /> PHONE: 5 209 396 3690 <br /> DATE: 13 ,DULY, 1990 <br /> EH 23 041 Revised 1/89 <br /> Administralion Clfnical Services Environmental Health Public Health Nursing <br /> 4138.3400 468.3830 488-3420 468-360 <br /> Air Pollution Community Services Laboratory WIC <br /> 488-3470 468-3820 488.3460 468.3280 <br /> AIDS Information 468.3820 <br />