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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> At Crow,Pres. <br /> Earl Pimentel,Vlce Pres. 1601 East Hazelton Avenue San Joaquin County <br /> Tommy Joyce,Secy. Stockton, California 95205 City of Manteca <br /> James F.Culbertson City of Escalon <br /> John D.Mast,M.D. JOGI KHANNA, M.D., M.P.H., DISTRICT HEALTH OFFICER City of Lodi <br /> Virginia Mathews City of Tracy <br /> Thomas Schubert,D.V.M. ENVIRONMENTAL HEALTH DIVISION City of Ripon <br /> Daphne Shaw (20'3) 468-3420 San Joaquin County <br /> Harvey Williams,Ph.D. City of Stockton <br /> San Joaquin County <br /> AUTHOFZ I ZAT I OM TO t@ELEASE <br /> re ANALYTICAL RESULTS <br /> GEOTECHNICAL DATA <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I , THE UNDERSIGNED OWNER AND/OP, OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 909 West Hammer Lane, Stockton, CA <br /> (STREET ADDRESS) (CITY) <br /> HEREBY AUTHORIZEApplied GeoSystens <br /> (LABORATORY or CONSONANT) <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 AVAILA2LE AND AT THE SAME TIME IT IS PROVIDED <br /> TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: Former Exxon Service Station Lys 7 lnsn <br /> (IF APPLICABLE) <br /> OWNER/OPERATOR: William Y. Wang Construction and Maintenance glgl_n r <br /> (PLEASE <br /> /)PRINT) (TITLE) <br /> (SIGNATURE) <br /> ADDRESS: 2300 Clayton Road Suite 1250 <br /> (NAILING ADDRESS) <br /> Coneord CA 94520 <br /> (CITY) (STATE) (ZIP) <br /> PHONE: ( 415 ) 246-8752 <br /> DATE: 6/ZF/lyY� I F; ECY: <br /> ,J 111 !SDI) <br /> EH 23 041 Revised 1/83 g <br /> APPLI i_ <br /> SACRAMENTO BRANCH <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 468-3400 468-3280 <br /> AIDS Information 468-3820 <br />