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eo1►gD OP 1R11>sTt " u_JOAQUIN LOCAL HEALTH Di- <br /> AI Crow,Pres, O � >iE1lVllt4 <br /> Fail Pirh Isk VIoa PrK 1601 E: st Hazelton Avenue than Joaquin Courtly <br /> TorrxnyJoKe.geay, Stockton.California 85205 city of M&McCc <br /> Janet P,Culboopon City 41 halon <br /> John 0,Matt MA. .IOGI KHANNA. M-D., M.RH., DISTRICT HEALTH OFftU C"y of Lodi <br /> VIfouva Meow" (qty of Tracy <br /> Thant,8011U0ert 0N.1.L ENVIRONMENTAL HEALTH DIVISIONcry et pupOn <br /> aphnt show' (209) 468-3420 San Joa4uln Cou" <br /> Haney wnw.lisnW nQty a 8hoctnon <br /> AUTH©R I ZAT' T ©N -r0 Ft ElL—I:rgBM am roahuin County <br /> ANALYTICAL. RESULTS <br /> ♦+- GEOTECHNICAL DATA <br /> 4* ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT I �% <br /> (SitEEI AlOAtSS1 (�tii'1 <br /> HEREBY AUTHORIZE_ <br /> llAd0AA14A1' or COJrddL11lrij�� ~ <br /> TO RELEASE ANY AND ALL ANALYTICAL RESULTOl GEOTECHNICAL DATA AND/OR <br /> ENVIRONMENTAL/SITK ASSESSMENT INFORMATION TO THE SAN JOAGUIN LOCAL HEALTH <br /> DISTRICT AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT 18 PROVIDED <br /> TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME 3 R .moi <br /> OWNER/OPERATOR! '&OADn 'STA T(- <br /> ,.1V�rPanlH�nlTA �l(,IrlEr- <br /> (PLEW tit <br /> (Sii ilrAE) 77- <br /> ADDRESS; P(3 - Box x S Z 5 2 <br /> f�Ea3G.n �n CA `?456(c, <br /> fC1IY1 (SiA1Fl (21�J <br /> PHONE <br /> s��}IS> `�Z6 — ���� <br /> �J <br /> DATE It <br /> KH 22 041 Rovised i/89 <br /> Admini CIInICaI 8ervksc EnvkW~tsl HeaM PuWk Health Nursing <br /> . <br /> 465-3420Alt Polluvon .386 <br /> Cal"Unly seMces Labor" WIC <br /> U-5-34TO 4115-3520 469-3M 488-3200 <br /> AIDS InlormaUOn 4U-9820 <br />