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0 i <br /> BOARD OF TRUataf s SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> At Crow,Pres, <br /> Earl Plmentet,Vico Pres. 1601 East Hazelton Avenue San Joaquin County <br /> Tommy Joyce,Secy. City of Manteca <br /> Stockton, California 95205 <br /> James F.Culbertson City of Escaion <br /> John 0.Mrlst,M.D. City of Lodi <br /> JpCil kHANNA, M.D., M.P.H., DISTRICT HEALTH pFPIC1cR City of Tracy <br /> Virginia Mathews <br /> Thomas Schubert,D,V,M. ENVIRONMENTAL HEALTH DIVISIONCity of Ripon <br /> 2fOS' C�8--34� <br /> Daphne Shaw r,4 San Joaquin County Harvey Williams,Ph.D. City of StocktonSart Joaquin County <br /> ^U-r IC3F;Z I ZA'T 101%4 -rO Fi!EL_E:AE3a <br /> -M ANALYTICAL RESULTS <br /> GEOTECHNICAL DATA <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 2216 Stewart Street, Stockton, Ca. <br /> (STREET ADDRESS) (CITY) <br /> HEREBY AUTHORIZE Conik Labratories � q�tC, <br /> (1AAORATORI 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 i Sabargun dumbing <br /> (Ii APPLICABLE! <br /> OWNER/OPERATOR: Tom Sabargun (Xrner <br /> (PLEAS pxlNr) rlrrcfs <br /> ( 16lfA1tfRf) <br /> ADDRESS: 2.27.6 Stewart Street <br /> (NA111k& ADDRESS) <br /> Stockton Ca, 95207 <br /> (0111) (STATE) (IIP) <br /> PHONE: ( 209 )474-2611 <br /> DATE: <br /> September 13,1989 <br /> EH 20 041 Revised 1/09 <br /> Administration Clinical Services Envlronmontel Health Publio Heallh Nursing <br /> 488.3400 468-3830 468-3424 <br /> 488.3A60 <br /> Air Pollution Community Sldrvipeg Le boratory <br /> 488-0470 46 3-38217 WfC <br /> 4eti-3480 488.3280 <br />