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BOARD OF TRUSTEES 0ROAQUIN LOCAL HEALTH D ., CT SERVING <br /> Al Crow,Pres. San Joaquin County <br /> Earl Plmental,Vlce Pres. 1601 East Hazelton Avenue City of Manteca <br /> Tommy Joyce,Secy. Stockton, California 95205 City of Escalon <br /> James F.Culbertson City of Lodi <br /> Jahn D.Mast,M.D. JOGI KHANNA, M.D., M.P.H.. DISTRICT HEALTH OFFICER City of Tracy <br /> Virginia Mathews City of Ripon <br /> Thomas Schubert,D.V.M. ENVIRONMENTAL HEALTH DIVISION San Joaquin County <br /> Daphne Shaw (209) 46(3-342o City of Stockton <br /> Harvey Williams,Ph.D. San Joaquin County <br /> AUTHOR I Z^-r I Oh! TO REL_E:AOa <br /> - - 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 8282 Veritas, Manteca, CA 95336 <br /> (STREET ADDRESS) (CITY) <br /> HEREBY AUTHORI ZE Canoni C Envi ronmental Stockton CA 209 983-1340 <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: <br /> AIF APPLICABLE) <br /> OWNER/OPERATOR: ' <br /> (PLEASE !N1) ,- --- (11TLE1 <br /> SI6NAfoR <br /> ADDRESS: 5a t?. -- <br /> (NAlLlNG ADDRESS)la <br /> (CITY) (STATE) (ZIP) <br /> PHONE: (26F ) 5,29 7/.�Zl <br /> DATE: <br /> EH 23 041 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 Laboratory WIC <br /> 468-3470 468-3820 466-3460 468-3280 <br /> AIDS information 468-3820 <br />