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- .•+ vrv� + a as 1u VV.! r .VG/ VL <br /> {OAKD O► TRUSTUA SAN JOAQUIN LOCAL HEALTH DISTRICT {EpVINC <br /> N Crow,Prea. {an Jowth Couny <br /> Earl NlmenlNV%A06, Pres. 1801 Epet MpzaltOn Avenue <br /> Tommy Joyce,s.oy Stockton,California 95205 City 01 Manlooa <br /> J411111111C Cdborgon Cly o!Escalan <br /> John D.Most M.D. 4001 KHANNA, M.D., M.RH., 016TFIICT HEALTH OFFIt:EIt city of LoN <br /> Vlrylnla Mathews Cly of Tracy <br /> Thomas schuua4 C.V.M. ENVIRONMENTAL HEALTH DIVISION Cly of Rlpaa <br /> Daphne show t209) 4f58-3420 UnJoaoulnCount$ <br /> Haney Williams,PhD. Chy of&I"*" <br /> pan Joaquin County <br /> I ZE•!"!' x CJIV TA REL.EZI;A1"alE' <br /> ANALYTICAL RESULTS <br /> 4e• GEOTECHNICAL DATA <br /> +y <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I , THE UNDERSIGNED OWNERS/AND/OR OPERATOR OF THE PROPERTY , AND/OR FACILITY <br /> LOCATED AT-_� - 13 3 /y/- 2 <br /> fliAEr! 41111[111 rUlr) <br /> HEREBY AUTHORIZE__ <br /> (LAIDAA1DAr er tONIIIIAN►) � <br /> TO RELEASE ANY AND ALL ANALYTICAL. RESULTSs 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 /> L4USINEaB NAMHt �ycz:/ V IC- KK ' I : /1 /< <br /> ad <br /> OWNER/OPERATOR1� �}� 1 V»? (� r j� I I', 1M S M L-y/ <br /> r►LEAIE /AlNI) f!lrLE) <br /> f lIMAIUA[) <br /> ADDRESSt /1 } <br /> e% Xe }� 7/ 7 <br /> f11AIL114 AII1El1) -- <br /> _. J ' 5PI '-,+ /,a <br /> rcrrn (s)A11) flip) <br /> PHONE t c 5111 37 / — �6' S-,S <br /> EH 23 041 RevtsOd L/1113 <br /> Admtnlstration Clinical Services 90Wronmantal Health PA11a H"111I Nurslfp <br /> • 180-3400 468.3030 46/•3120 466•Mait <br /> Air p011u6on COMMunty Sarvio0s Lobo+o, ry 1MC <br /> 4aa•94ro 466.96x0 468-3160 <br /> 466•x!b <br /> AIDS Information 466-seta , <br /> ..T/T •a OltJ31,10J0US M X13 GT :ET 68, 80 AON <br />