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BOARD OF TRUSTEES S JOAQUIN LOCAL HEALTH DIICT SERVING <br /> Al Crow,Preg. <br /> - Earl.Pimentel,vice Pres. 1601 East Hazelton Avenue San Joaquin County <br /> City of Manteca <br /> Tommy Joyce,Sec'y. Stockton, California 95205 City or Manteca <br /> James F.'Culbertson <br /> John 0.Mask M.D. JOGI KHANNA, M.D., M.P.H., DISTRICT HEALTH OFFICER City of Lodi <br /> Virginia Mathews Ciy of Tracy <br /> Thomas Schubert D.V.M. ENVIRONMENTAL HEALTH DIVISIONCity of Ripon San Joaquin I Daphne Shaw County <br /> Harvey Williams,Ph.D. <br /> (209) 4G8-342i> City of Stockton <br /> San Joaquin Count' ' <br /> AU-T- 0F2I ZA-I I Oh! TO E aL-E:ASE <br /> ANALYTICAL RESULTS <br /> GEOTECHNICAL DATA <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> 1 I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT--2-88--EAST--6TH STREET FRENCH CAMP <br /> (SIP,EET ADDRESS) (CITY) <br /> HEREBY AUTHORIZE CANONIE ENVIRONMENTAL SERVICES <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: SAME <br /> I (IF APPLICABLE) <br /> (`?As vpR <br /> OWNER/OPERATOR: MRS. MASUDA -_ OWNER <br /> (PLEASE PRINT) (TITLE) <br /> l IGNATURE) --" <br /> ADDRESS: _p-o- <br /> (MAILING ADDRESS) <br /> FRENCH CAMPL CALIFORNIA 95231 <br /> (CITY) (SIATE) aIn <br /> PHONE: ( 209 j 982_0226 <br /> DATE: r <br /> EH 20 041 Revised 1/89 <br /> Administration Clinical Services Environmental Health Public Health Nursing <br /> 468.3400 468-3830 468-3420 468.3860 <br /> Air Pollution Community Services Lnboratory WIC <br /> 468.3470 468-3820 468-3460 468-3280 <br /> AIDS Information 4RR-1ron <br />