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SITE INFORMATION AND CORRESPONDENCE
EnvironmentalHealth
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3500 - Local Oversight Program
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PR0545913
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SITE INFORMATION AND CORRESPONDENCE
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Last modified
7/27/2020 7:28:02 PM
Creation date
7/27/2020 4:34:56 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
SITE INFORMATION AND CORRESPONDENCE
RECORD_ID
PR0545913
PE
3528
FACILITY_ID
FA0005531
FACILITY_NAME
TEXACO SERVICE STATION
STREET_NUMBER
941
Direction
E
STREET_NAME
YOSEMITE
STREET_TYPE
AVE
City
MANTECA
Zip
95336
CURRENT_STATUS
02
SITE_LOCATION
941 E YOSEMITE AVE
P_LOCATION
04
P_DISTRICT
003
QC Status
Approved
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EHD - Public
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r. <br /> 60ARr3 fSF TRUSTEES ' SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> James Culbertson, Pres. City of Lodi <br /> Patricia El Vannuccl, sec'y. 1601 East Hazelton Avenue, P. O. Box 2009 San Joaquin County <br />- Anthondtte Van Spronsen City of Escalon <br /> Earl Pimentel Stockton, California 95201 City of Manteca <br /> Fern 6ugbee 209/466-6781 City of Ripon <br /> Daniel L. Flores City of Stockton <br /> John D. Mast, M.D. City of Tracy <br /> William J.Wade Jogi Khanna, M.D., M.P.H., Metrict Health Officer San Joaquin County <br /> Mary Anna Love San Joaquin County <br /> AUTHORIZATION TO RELEASE_ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> I, the undersigned owner and/or operator of the property and/or facility. <br /> Iocated at 941 East Yosemite Avenue <br /> hereby authorize . Applied Geos stems <br /> to release any and all analytical results, geotechnical data and site <br /> assessment information to the San Joaquin Local Health District as 'soon <br /> as it is available and at the same time it is provided to me or my <br /> representative. <br /> i <br /> Owner/Op Ti tl e: L <br /> Address car-- 1 r _ Phone:. <br /> i <br /> r ..hate: <br /> EH 08 05 <br />
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