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BOARD OF TRUSTEES <br />At Crow, Pres. <br />Earl Pimentel, Vice Pros, <br />Tommy Joyce, Sec'y. <br />James F. Culbertson <br />John D. Mast M.D. <br />Virginia Mathews <br />Thomas Schubert D.V.M. <br />Daphne Shaw <br />Harvey Williams, Ph.D. <br />0 0 <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1601 East Hazelton Avenue <br />Stockton, California 95205 <br />JOGI KHANNA, M.D., M.P.H., DISTRICT HEALTH OFFICER <br />ENVIRONMENTAL HEALTH DIVISION <br />(209) 468-3420 <br />'�Pk x/893 <br />AIJTHOFc I ZAT I ON TO FZELEASE <br />'ai- ANALYTICAL RESULTS <br />-W GEOTECHNICAL DATA <br />'4+- 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/OP, OPERATOR OF THE PROPERTY AND/OR FACILITY <br />LOCATED AT 8590 West Valpico Road Tracy <br />(STREET ADDRESS) (CITY) <br />HEREBY AUTHORIZE BSK & Associates, Pleasanton, CA. <br />(LABORATORY or CORSOLTANT) . <br />TO RELEASE ANY AND ALL ANALYTICAL RESULTS, GEOTECHNICAL DATA AND/OR <br />ENVIP.ONMENTAL/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 • n/a <br />(IF APPLICABLE) <br />OWNER/OPERATOR: Mrs. Ann Tugel Owner <br />(PLEASE PRINT) (TITLE) <br />x �O _ <br />(S16RAIURE) <br />ADDRESS: P.O. Box 6, <br />(NAILING ADDRESS) <br />Tracy, CA. 95378-0006 <br />(CITY) (STATE) (IIP) <br />PHONE: ( 209) 835-1719 <br />DATE: x ;�±, 16, / y ge <br />EH 23 041 Revised 1/89 <br />Administrallon <br />468-3400 <br />Air Pollution <br />468-3470 <br />Clinical Services <br />468-3830 <br />Community Services <br />468-3820 <br />AIDS <br />Environmental Health <br />468-3420 <br />Laboratory <br />468.3460 <br />Public Health Nursing <br />468-3860 <br />WIC <br />468-3280 <br />