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BOARD OF TRUSTEES SA*OAQUIN LOCAL HEALTH DIST iT SERVING <br /> Al C,v%4,Pres. <br /> Earl Pimentel,vice Pres. 1601 East Hazelton Avenue San Joaquin County <br /> City o <br /> Tommy Joyce,Secf Manteca <br /> Secy. Stockton, California 95205 City f Manteca <br /> James F.Culbertson <br /> John D.Mast,M.D. JOGI KHANNA, M.D., M.P.H., DISTRICT HEALTH OFFICER City of Lodi <br /> City of Tracy <br /> Virginia Mathews <br /> Thomas Schubert,D.V.M. ENVIRONMENTAL HEALTH DIVISIONCity of Ripon <br /> San Joaquin County <br /> Harvey Williams,Ph.D. <br /> Daphne Shaw ('2C-0) 41,8-34'A2t j City of Stockton <br /> San Joaquin County <br /> AUTHOF� I ZaT I ON TO FRELEASE <br /> - - ANALYTICAL RESULTS <br /> - - GEOTECHNICAL DATA <br /> - - ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I , THE UNDERSIf3NED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT West Weber Avenue and North Lincoln Street <br /> (STREET ADDRESS) (CITY) <br /> HEREBY AUTHORIZE Applied GeoSystems <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 /> BUSINESS NAME: Qity of Stockton Comunity Developmnt Department <br /> (IF APPLICABLE) <br /> OWNER/OPERATOR: Robert A. Sivell Pro e-ct Geolo ist �� �G Neth C: <br /> SE PRINT) (TITLE) <br /> (SIGNATURE) <br /> ADDRESS: 42.5 North E1 Dorado Street <br /> (MAILING ADDRESS) <br /> _Stockton CA 95202-1997 <br /> (CITY) (STATE) (ZIP) <br /> PHONE: (209 :f 944-8538 <br /> DATE: 6 .,�-6Ify <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 468-3920 <br />