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BOARD OF TRUSTEES <br />SAM �-AQUIN LOCAL HEALTH DISTI�of <br />SERVING <br />At Crow. Pies. <br />Earl F imomel; vlca Pras. <br />1601 East Hazelton Avenue <br />San Joaquin Count' <br />Tommy Joyce, Sec'y. <br />Stockton, California 95205 <br />City of Manteca <br />City of Escelo <br />James F. Cu!bertson <br />John D. Mast, M.D. <br />JOGI KHANNA, M.D.; M.P.Ii., DISTRICT HEALTH OFFICER <br />city o1 loci <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 />Harvey Williams, Ph.D. <br />(209) -468-3420 <br />City of Stockton <br />San Joaquin County <br />ALJTHOFR I ZAT 2 OhJ T'(D FS a:LLEAE3E <br />-w- ANALYTICAL RESULTS <br />-K-,GEOTECHNICAL DATA <br />ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br />I, THE <br />UNDERSIGNED OWNER AND/OR OPERATOR,OF THE PROPERTY AND/OR <br />FACILITY <br />LOCATED <br />AT T—r—r5 <br />N. <br />PEt;SN i NG A\JE S-roff-K-rtD tJ 6A <br />9 520 <br />t iXttl 4OORE55) I(CITY) ' <br />HEREBY AUTHORIZE CAh-CWlF- LAsos?-AT012LEs <br />(L480R4IORY or COHSR UXI) <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:_ '5HCFW-- OIL- I <br />(IF APPLICABLE) <br />1OWNEP./OPERATOR: <br />(TITLE) <br />(SIGNATURE) V <br />ADDRESS: per- `SOX O <br />• lNAIIIRG ADDRESS) ' <br />�a q s2o <br />(CITY) ISIAIE) rZIP) <br />PHONE: <br />DATE: FEB. 23, 1990 <br />EH 23 041 Revised 1/8.3 <br />Administration <br />Clinical Servicos Environmental Health <br />466-3400 <br />468-3830 468-3420 <br />Air Pollution <br />Community Services laboratory <br />468-3470 <br />468-3820 . 468-3460 <br />AIDS Information 468-3820 <br />Public Hoalih Nursing <br />468-3860 <br />WIC <br />468-3280 <br />