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BOARD OF TRUSTEES <br />At Crow,Pres. <br />,Earl Pimentel, Vice Pres. <br />Tommy Joyce, Secy. <br />James F. Culbertson <br />John D. Mask M.D. <br />Virginia Mathews <br />Thomas Schubert D.V.M. <br />Daphne Shaw <br />Harvey Williams, Ph D. <br />^U -r I01R I ZAT I ON TO RELEASE <br />SACOAQUIN LOCAL HEALTH DISJOCT <br />1601 East Hazelton Avenue <br />Stockton, California 95205 <br />JOGI KHANNA, M.D., M.P.N., DISTRICT HEALTH OFFICER <br />ENVIRONMENTAL HEALTH DIVISION <br />(209) 468-3420 <br />-W ANALYTICAL RESULTS <br />ae- GEOTECHNICAL DATA <br />-o+ ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br />SERVING <br />San Joaquin County <br />City of Manteca <br />City of Escalon <br />City of Lodi <br />City of Tracy <br />City of Ripon <br />San Joaquin County <br />City of Stockton <br />San Joaquin County <br />I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br />LOCATED AT 25499 E. SHELTON ROAD, LINDEN, CA <br />(STREET ADDREss) (City) <br />HEREBY AUTHORIZE FOL Envirnnmental 2500 Stagecoach Rd Stocleton CA (209) 942-0181 <br />(LABORATORY or CONSULTANT) <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:4<4<c f 1' S ✓f' �7 5 S c.?-� cCr� 1r <br />Lflf AMICABLE) <br />OWNER,/OPERATOR.: li='h '/ G i e✓ `�« R/ C s io% f /'L <br />ULEASE PRIN►ifr� (TITLE) <br />(SfBNAlURE) <br />ADDRESS: <br />(AAlLIN6 ADDRESS <br />lC��/cc I L G l <br />(CITY) (STATE) (lip) <br />PHONE: <br />DATE: <br />EH 23 041 Revised 1/89 <br />Administration <br />Clinical Services <br />Environmental Health <br />468-3400 <br />468-3630 <br />468-3420 <br />Air Pollution <br />Community Services <br />Laboratory <br />468-3470 <br />466-3820 <br />468-3460 <br />AIDS Information 468.3820 <br />Public Health Nursing <br />468.3860 <br />WIC <br />468-3280 <br />