Laserfiche WebLink
BOAR OF TRUSTEES SAN J AQUIN LOCAL HEALTH DISTRICT <br />James Culbertson, Pres. <br />Palrlcla E. Vannuccl, Secy <br />Anlhonette Van Spronsen <br />Earl Plmenlel <br />Fern Bupbee <br />Daniel L. Flores <br />John D. Mast, M.D. <br />William J. Wade <br />Mary Anna Love <br />1601 East Hazelton Avenue. P. O. Box 2009 <br />Stockton, Callfornia 95201 <br />209/466-6781 <br />Jopl Khanna, M.D., M.P.H., District Health Officer <br />AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br />SITE ASSESSMENT INFORMATION <br />I, the undersigned owner and/or operator of the property and/or facility <br />located at SES CS Sl i0 /7)jejPtc )fVE/ , 54-oe/e7-6A) <br />hereby authorize G- .— T_=7 "!S <br />to release any and all analytical results, geotechnical data and site <br />dssessment information to the San Joaquin Local Health District as soon <br />as it is available and at the same time it is provided to me or my <br />representative. <br />SERVING <br />City of Lodl <br />San Joaquln County <br />City of Escalon <br />City of Manteca <br />City of Ripon <br />City of Stockton <br />City of Tracy <br />San Joaquin County <br />San Joaquin County <br />Owner/Operator: AQ(k)t,_% <br />(A— <br />Title: <br />Q�7 P9u15D� <br />Address <br />AyE <br />Phone: <br />E673 73GO <br />Date: <br />r <br />EH 08 05 UGT 13 <br />Fczalyzo <br />SEP 10 1986 <br />ENVIROMENTAL HEALTH <br />PERMIT/SERVICES 60 <br />19A` j80 <br />