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AI Crow, Prea. <br />-^ VAPtAIIII`/ LUUAL MtALiH DISTRICT <br />_ <br />SERVING: <br />' Earl Pimentel, Vice Pres.- <br />mmy,loycertson <br />1601 East Hazelton Avenue <br />San Joaquin Count'; <br />.. a <br />James F. Culbertson <br />Stockton, California 95205 <br />city of Manteca; <br />John D. Mast, M.D. <br />Virglnla Mathews <br />JOGI KHANNA, M.D., M.P.H., DISTRICT HEALTH OFFICER <br />City of Escabn' <br />Crtyol(pd; <br />DaphnThomaeShaw SchubegD.V-M. <br />Daphne <br />ENVIRONMENTAL HEALTH DIVISION <br />City of Tracy <br />City of Ripon <br />' Harvey Williams. Ph.D. <br />(=-! 1:J) 460-34<'i) <br />San Joaquin <br />quip CouwjIY.. <br />- <br />Cit' o! Stockton <br />AUTHOR I ZAT I ONSan <br />TO RELEASE <br />Joaquin County`. <br />ANALYTICAL RESULTS <br />OCT 9.jy90� <br />OEOTECHNICAL DATA <br />"""ARJNNICNTALHF <br />ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br />ccT,�NIT/SEt21,r., <br />;I <br />I, T THE-UNDEP.SI''7GN�ED OWNER AND/OR OPERATOR' OF THE PROPERTY AND/OR FACILITY <br />_ LOCATED AT/ c3 G S �e./� (Zo e - Re4rl L. O j T C <br />(S1REU ADDRESS) (CITY) HEREBY AUTHORIZE % T _ ��- �1 -� ) �- E .r..S <br />n R or CONSULNE) tt'I til i.)Arr <br />uu <br />TO RELEASE ANY ANDALL ANALYTICAL RESULTS, GEOTECHNICAL DATA AN D OP (o62 ` <br />/ <br />ENVIRONMENTAL/SITE ASSESSMENT INFORMATION TO THE SAN JOAQUIN LOCAL HEALTH <br />DISTRICT AS SOON AS IT IS AVAILAI(LE AND AT THE SAME TIME IT IS PROVIDED <br />TO ME OR MY REPRESENTATIVE. <br />BUSINESS NAME: <br />(IE APPLICABLU <br />OWNER/GPgRA^T-gp, c7o S4A)Zb 4AP�IYtlnJMe<Jfa <br />(PLEASE PR1�R1) 0.AlcageT- <br />(1!I LU <br />ADDRESS: <br />Se <br />(CITY) <br />PHONE: (AOG <br />ZU <br />es; <br />ADDRESS) <br />=Ji1L! <br />6JI4 <br />Q <br />rs'IATU (ZIP) <br />DATE: OG7`a�eY l� 199d <br />EH 23 041 Revised 1/99 <br />Administration Clinical Servicas Environmental Health <br />468-3400 468-3830 <br />468-3420 <br />Air Pollution Community Sorvices <br />468-3470 468-3820 Laboratory <br />468-3460 <br />AIDS Intormution 468-387n <br />Public Health Nursing <br />468-3860 <br />WIC <br />468-3280 <br />