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GGARR'OF TRUSTEES SA JOA>,QUIN LOCAL HEALTH D:ST 1QT SERVING <br /> 'AI Crow,Pres: San Joaquin County <br /> Earl Pimentel,Vice Pres. 1601 East Hazelton Avenue City of Manteca <br /> Tommy Joyce,Secy. Stockton, California 952055 City of Escalon <br /> James F.Culbertson City of Lodi <br /> John D.Mast,M.D. JOGI KHANNA, M.D., M.P.H., DISTRICT HEALTH OFFICER City of Tracy <br /> Vfrginia Mathews City of Ripon <br /> Thomas Schubert,D.V.M. ENVIRONMENTAL HEALTH D I V I S I DIV San Joaquin County <br /> Daphne Shaw C)9 7 4Gt3—'34'1.4; City of Stockton <br /> Harvey Williams,Ph.D. San Joaquin County <br /> ANALYTICAL RESULTS <br /> - GEOTECHNICAL DATA <br /> -X- ENV I RDNIIENTAL/SITE ASSESSMENT INF-CURMAT I ON <br /> 1 , THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/D[- FACILITY <br /> LO :APED AT 260AM <br /> s .L1LTH_(�RNT—W, ROAD THORNTON <br /> (STPEE ADDRESS) fCITY} <br /> HEREBY AUTHORIZE (_ At— tiIJ,�,�Y�✓ <br /> (L980P,A10PY or CBSULTBT) <br /> TO RELEASE ANY AND ALL AhIALYTIC.'AL F�:ESLJL-T'S, GEOTE1==HNICAL DATA AND/DR <br /> ENV IRONMENTAL/S I TE ASS(=SSMENT INFORMATION TO THE SAN .?OAOU IN LOCAL HEALTH <br /> DISTRICT AS SOON AS IT IS AVAILADLE AND AT THE SAME TIME IT IS PROVIDED <br /> TO ME OR MY REPRESENTATIVE., <br /> ;;``�� (I" APPLICABLE) <br /> OWNER/OPEC?ATOR:>`r ,(JON je�? <br /> (PL SE !'P } (TITLE) <br /> (SIc.YATURE) <br /> /';?4? z?-, <br /> 0,4HNG AVv fSS► <br /> (CITY) (STATE} (ZIP) <br /> PHONE.: 4 7/v) <br /> DA <br /> EH 041 Revised 1/09 <br /> Administration Clinical Services Environmental Health Public Health Nursing <br /> �(,(= 468-3400 468-3830 468-3420 468-3860 <br /> Air Pollution Community Services Laboratory WIC <br /> 468-3470 468-3520 468-3460 468-3280 <br /> AIDS In1cr^7u'fon 468-3820 <br />