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BOARD OF TRUSTEES <br />SAN JOAOUIN LOCAL HEALTH DIST <br />AI Crow, Pres. <br />SERVING <br />Earl Pimentel, Vice Prez. <br />1601 East Hazelton Avenue <br />San Joaquin County <br />Tommy Joyce, Secy- <br />Stockton, California 95205 <br />Cly o1 Manteca <br />City of Escaion <br />James F. Culbertson <br />City of Lodi <br />John D. Most, M.D. <br />JOGI KHANNA, M.D., M.P.H., DISTRICT HEALTH OFFICER <br />City of Tracy <br />Virginia Mathews <br />City of Ripon <br />Thomas Schubert. D.V.M. <br />ENVIRONMENTAL HEALTH DIVISION <br />San Joaquin County <br />Daphne Shaw <br />( 203) 468-3420 <br />City of Stockton <br />Harvey Williams, PhD. <br />San Joaquin County <br />AUTHOFR I ZAT I ON TO FZE:L-EAE-3E <br />++ ANALYTICAL RESULTS <br />-94- GEOTECHNICAL DATA <br />-1+ ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br />Ir THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OP. FACILITY <br />LOCATED AT <br />(SfAEEI"AUORESS. (City) <br />HEREBY AUTHORIZE f nonie Environmental, Stockton CA 983-1340 <br />(E4110RAl0illy or CONSUEIANO <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. <br />BUSINESS NAME: <br />OWNER/OPERATOR.: <br />ADDRESS: <br />(IF--ffANEICADEE) <br />(/(EASE GJtN11,' --- - (TITLE) <br />1 f <br />(RA1(116 ADDRESS) <br />(City) (SIAIEI (III) <br />PHONE: <br />s <br />DATE: <br />EH 23 041 Revised 1/89 <br />AdminlafraVon Clinical Services Environmental Health <br />468-3400 468.3830 468-3420 <br />Air Pollution Community Services Laboratory <br />468-3470 468.3820 468-3460 <br />AIDS Information 468.3820 <br />Public Health Nursing <br />468-3860 <br />WIC <br />468.3280 <br />