Laserfiche WebLink
10ARD OF TRUsnu <br /> Al 5row,PM SAN JOA( —N LOCAL HEALTH DISTRICT <br /> EM p6wtMl.*a PrN, SERVING <br /> Tonft-* .Selly 1601 East Hazellon Avenue Sen Joaquin County <br /> Jellye F.Culbertson Stockton, California 95205 Cly of Manteca <br /> JoM D.Mast M.D. JOGI KHAN City of Ea"on <br /> mminfe Me"" NA, M.D., M.P.M. DISTRICT HEALTH OFFICER Cly of Looi <br /> City <br /> Thom" <br /> City <br /> �w erlO.V.IL ENVIRONMENTAL HEALTH DIVISION Cly of(LOfNacy <br /> yon <br /> IWwyW1111emt,Ph.D. (20.3) 468-3420 San Joaquin County <br /> City of Stockton <br /> AU-rHOFi I ZA-r I ON TO R E L E A S E San Joaquin County <br /> 'I'll ANALYTICAL RESULTS <br /> 44- GEOTECHNICAL DATA <br /> �+ ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> Ir THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT a "-I I R u -&J S 0 A �—A ' -+b`L-f <br /> (SIIEEI /IIIESS)�` ' (Lill) <br /> HEREBY AUTHORIZE _ s �S X C2 << � , �. ��A (r�� 0 g+ <br /> TO RELEASE ANY AND ,ALL ANALYTICALASRESULTSr 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 REPREESENTATIVE. <br /> BUSINESS NAMES f,bj'(/ vL by I i ELL Lo <br /> (lE AIIIIC,ArIIE) <br /> OWNER/OPERATOR: /f' s' �h/sC t �✓,,�••,L S <br /> (IlEISE Irlrl) UHLE) <br /> rsturAlrA��E) <br /> ADDRESSe 11� <br /> ("i1116 AIDAESS) <br /> (0111) (SIAIE) (IU) <br /> PHONEI 19S `11uI <br /> DATE? J(1�C.{ c � a �` 1'150 <br /> EH 23 041 Revised 1/89 <br /> Adminletre0on Clinical Servicoo Environmental Haatm Public Hoalth Nureln <br /> 460-3400 468-3830 468.3420 468.3860 0 <br /> Air Pollubon Community Services Laboratory WIC <br /> 468.3470 468.3620 468.3460 468-3200 <br /> AIDS Information 468.3820 <br />