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BOARD OF TRUSTEES SAN'J'OAQUIN LOCAL HEALTH DISTRXT SERVING <br /> At Crow,Pre$, Sen Joaquin County <br /> Earl Pimentel,Vice Pres. 1601 East Hazellon Avenue City of Manteca <br /> Tommy Joyce,Secy. Stockton, California 95206 City of Eecsfon <br /> James F.Culbertson City of Lodl <br /> John D.Mast,M.D. JOGI KHANNA. M.D., M.P.H., DISTRICT HEALTH OFFICER City of Tracy <br /> Virginia Mathowa City of Ripon <br /> Thomas Schubert 0M.M. ENVIRONMENTAL HEALTH DIVISION Son Joaquin County <br /> Daphne Shaw (209) 468-3420 city of Stockton <br /> Hervey Wllllame,Ph.D, San Joaquin County <br /> AU-rH0R I z^-r 1 ON TO mm"M^ m <br /> i+ ANALYTICAL RESULTS <br /> 'ka• GEOTECHNICAL DATA <br /> s4 ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> Ir THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> ti <br /> LOCATED A7 455 West Grant Line Road Tracy .. . <br /> (SIREV ADDRESS) ftllYl <br /> HEREBY AUTHORIZE American Environmental Management Corporation <br /> (IASORAIORY of CORS111I4)(f) <br /> TO RELEASE ANY AND ALL ANALYTICAL RESULTS, [GEOTECHNICAL DATA AND/OR <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION TO THE SAN J'OAQUIN LOCAL HEALTH <br /> DISTRICT AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED <br /> TO ME OR MY REPRESENTATIVE. 1"I"I <br /> BUSINESS NAME: 7-11 <br /> R/OT (lf AIIUCAAIE) pOR: Dave Lamm,-, Southland Corp. <br /> UEFASE PRlN1) (TIT110 <br /> L <br /> (S S11AIURE <br /> ADDRESS, 655 University Drive , Suite 104 <br /> (1141(118 ADDRESS) <br /> Sacramento, ? CA 95825 <br /> (CITY) (STALE) (E1P) <br /> PHONE: ( 916 ) 927-8155 <br /> �( <br /> DATE: <br /> EH 23 041 Revised 1/89 y i <br /> Administration Clinical Services Environmental Health Public Health Nursing <br /> 468.3400 488.3830 488-3420 488.3860 <br /> Air Pollution Community Service$ Laboratory WIC ' <br /> 460.0470 466.3620 486.3160 466.3260' <br /> Woa:1 <br />