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Zr 4152852374 INDUSTRIAL NANAG 02/02/90 11 :48 P03 <br /> John-D.leMaar,MA.Mathews ...i KHANNA, M.D., M.P.H., DISTRICT HEALTH Qp,�ER Clry o <br /> VIry1Me f Lo0i <br /> Thomas Schubert,D.V.M. City of Tracy <br /> Daphne Shaw, ENVIRONMENTAL HEALTH DIVISION City of Ripon <br /> Harvey Williams,Ph.D. (209) 448_3420 San Joaquin County <br /> City of Stockton <br /> AUTHOFR T ZAT = N TC7 RELSan Joaquin County <br /> CaEASE <br /> -P+ ANALYTICAL RESULTS <br /> 4kl GEOTECHNICAL DATA <br /> s+ ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR Of THE PROPERTY AND/OR FACILITY <br /> LOCATED <br /> (fTREfI AO6RfSSJ (Cr1YJ <br /> HEREBY AUTHORIZE /ATERWORK, ESCALON, CALIFORNIA <br /> 01004109y OF <br /> TORELEASE 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 AVAILAC+LE AND AT THE SAME TIME IT IS PROVIDED <br /> TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: <br /> (R APPLICAALf) ---• <br /> OWNER/OPERATORyL� <br /> (PLEA PR[ <br /> lS/1BNA]UREJ <br /> ADDRESS: > E?Z <br /> (AAf(fMli ADDRESS) — - <br /> fcIty) - <br /> rcrrrJ rs1A/EJ rrlPJ <br /> PHONE: c J 2 ZZ _� SG9— 2ct�5 <br /> =DATE-: ------.-._..__. <br /> �- <br /> EH 23 041 Revised 1/89 <br /> Administration Clinical Servictis Environmental Health <br /> 468-3400 466.3830 466.3420 Public 1-10411h Nursing <br /> 466.3660 <br /> Air Pollution Community Services Laboratory "'•—'-- <br /> 468.3470 468 40 <br /> 3620 WIC <br /> 6-3460 468.3280 <br /> AIDS Inlormaflon 468.3840 <br />