Laserfiche WebLink
T 15: 1E-, 14ALT01I -Ii IEERD1i_ P. 3,/3 <br /> BOARD OF TAUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SY.RvtNG <br /> Al Crow,Ares, San Joaquin County <br /> Earl Pimentel,V"Ce tales. 1601 East Hazelton Avenue City of Manteca <br /> Tornmy aoyca,Secy. Stockton, California 95205 City ofEcalon <br /> James F.Culbertson City a <br /> John D.Mast M_D. JOGI KHANNA, M.D., KRII., DISTRICT HEA4TH OFF?CER City of Tracy <br /> Virginia Mathews City of Ripon <br /> Thomw Schubert,D.V.M. ENVIRONMENTAL HEALTH DIVISION San Joaquin County <br /> Daphne Show (219.9) 468-3420 city 01 Stockton <br /> Harvey WilOdnrs.Ph.D. San Joaquin County <br /> r�eL -r C:pF;Z I Z A" C7h1 -r(3 FZE:L[—=ASE <br /> tet- ANALYTICAL RESULTS <br /> -X- GEOTECHNICAL DATA <br /> -W ENVIRC7NMENTAL/SITE ASSESSMENT INFORMATION <br /> I , THE UNDERSIGINCD OWNER AND/OR OPERATOR OF THE PPOPE€?TY AND/OR FACILITY <br /> LOCATED AT JOD 1.- Vf)L-,PJ (--i) La-;_-- - = --- - <br /> {ytR£fI ANNESS) (ury) <br /> HEREBY AUTHORIZE (�.-� , tLa a <br /> 6 r-✓i �. <br /> fWOWORY of CONSULTANT) <br /> TO RELEASE ANY AND ALL. ANALYTICAL RESULTS, 6EOTECHNICAL DATA ANIS/OR <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION TO THE SAN JOAQUI fit LOCAL HEALTH <br /> DISTRICT AS SOON A5 IT IS AVAILABLE AND AT THE SAME TIME IY IS PROVIDED <br /> TO ME OR MY REPRESENTATIVE, <br /> BUSINESS NAME: ,--- <br /> 0 <br /> AME: ,d....__ <br /> lrl: RPPtICifBC✓:) <br /> AtA�s PrNr} (rlrtF) <br /> lSIBNAIl1RE} <br /> ADDRESS: ---- --- - ---- — - - <br /> (841 0 ADDRESS) <br /> lClT?'} lSTA1El IdTP} <br /> PHONE: <br /> DATE: <br /> EH 23 041 Revised I/Sri <br /> Adminia:raton cinleai Service t; Public Hoallh Nursing <br /> 468.3400 4r -383a 468-3420 468.3864 <br /> Air Pollution community Services Iitx7raicry 1NtC - <br /> 468-3474 468.3820 468- 400 468-326D <br /> AIDS informalion aF,$-3820 <br />