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BOARD of TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> N Crow,Pres. San Joaquin County <br /> Earl Plmentel,Vice Pres. 1601 East Hazelton Avenue City of Manteca <br /> Tommy Joyce.Secy. Stockton, Calilornla 95205 City of Escalon <br /> James F.Culbertson City of Lodi <br /> John D.Mas(M.D. JOGI KHANNA, M.D., M.P.H., DISTRICT HEALTH OFFICER City of Tracy <br /> Vlrglnla Mathews City of Ripon <br /> Thomas Schubert D.V.M. ENVIRONMENTAL HEALTH DIVISION San Joaquin County <br /> Daphne Shaw (20.3) 468-3420 City of Stockton <br /> Harvey Williams,Ph.D. San Joaquin County <br /> AUTHOR I :Z ^-r I ON TO F2ELEAt3E <br /> -14- ANALYTICAL RESULTS <br /> -+4- GEOTECHNICAL DATA <br /> -0+ ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I , THE UNDERSIGNED OWNER AND/OR OPERATOR. OF THE PROPERTY AND/OR FACILITY <br /> I <br /> LOCATED ATCCM�TRrr� 4 P Pf �ilE2�IiJCt �al/1e� �TaeTL ✓� CA <br /> (S(REEI Ato�E551 \ fl <br /> HEREBY AUTHORIZEGl�L tF �L� ATE( 1�J�3 �Pl Dk�: TuJL go PAO(Y&ro �C'A <br /> (LANonroAr or foNSol1AN1) <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. /� n <br /> BUSINESS NAME: SRA) T'Aoc//a) <br /> �7 (!f ANL CANIEJ <br /> OWNER/OPERATORS /7�FE�T ��/�' /G J"/ unitz'4 <br /> (PIERS[ PRINII f11 <br /> r:tsNAE;W1z <br /> ADDRESS: P- //3 1 <br /> (RAILINA AI fSS) <br /> (Cllr) rsrerfJ rurJ <br /> PHONE: <br /> DATE: <br /> EH 23 041 Revised 1/89 <br /> Administration Clinical Services Environmental health Public Health Nursing <br /> 468-3400 468-3830 468-3420 468-9860 <br /> Air Pollution Community Services Laboratory WIC <br /> t 468-3470 468-3820 468-3460 488-3280 <br /> AIDS information 468-3820 <br />