Laserfiche WebLink
. 'BOARD OF TRUSTEES • • <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> Al Crow,Pres. SERVING <br /> Earl Pimentel,Vice Pres. 1601 East Hazelton Avenue San Joaquin County <br /> Tommy Joyce,Secy. Stockton, California 95205 City of Manteca <br /> James F.Culbertson City of Eacalon <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 ('[t)9) 468-342q San Joaquin County <br /> Harvey Williams,Ph.D. City of Stockton <br /> AU-r"C3FR I ZAT I ON TCS RELEASE San Joaquin County <br /> E::: 4+ 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 b CSO A/T/ 7-Nnr? afT <br /> HEREBY AUTHORIZE (Slgf� RS <br /> I gODRE�S to (CITY) <br /> ILH5119fifORT 0? <br /> TO RELEASE ANY AND [AALL( AN[ALYTICALRESULTS, 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: S <br /> (IE APPLICABLE) <br /> OWNER/OPERATOR.: n/1 Z r� <br /> — (TALE) <br /> C <br /> (S16NAIU <br /> ADDRESS: SI�r <br /> (AAILIN6 ADDRESS) <br /> (carr) (STATE) (IIP) <br /> PHONE: ( 0 7 / Y — 7 -Sof <br /> E <br /> TE: <br /> EH 23 041 Revised 1/89 <br /> Administration Clinical Services tal EnvlronmanHealth <br /> 468.3400 468-3830 468 Environmental <br /> Public Health Nursing <br /> 468-3860 <br /> Air Pollution Community Services Laborato -- <br /> 468-3470 468.3820 4G8-3400 WIC <br /> 468-3280 <br /> AIDS Information 468-3820 <br />