Laserfiche WebLink
BOARD OF TRUSTEES "JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> At Crow,Pres. San Joaquin County <br /> Earl Pimantet,Mee 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 /> John 0.Maar,M.D. JOG[ 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) 468-3420 City of Stockton <br /> Haney Williams,PhD. San Joaquin County <br /> AUTHOR I ZAT I MN -rM RELEA0E: <br /> -ft- <br /> ANALYTICAL RESULTS <br /> -�- GEOTECHNICAL DATA <br /> -�* ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> Ir THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY ANA/OR FACILITY <br /> LOCATED AT 8282 Veritas, Manteca, CA 95335 <br /> (STREET ADDRESS) (CITY) <br /> HEREBY AUTHORIZE FGL Environmental Stockton, CA (209) 942-0181 <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: GU, 4e5 1Yi C YI C <br /> (r Ai'FLrCABtE) <br /> OWNER/OPERATORS . ' <br /> (r"[ERS RrNrJ (rrrtEJ <br /> SNATUREJ <br /> r <br /> ADDRESS: A.� 2 �� �, <br /> (RAI(TNS ADDRESS) <br /> (CITY) (STATE) (ZIP) <br /> PHONE: C7-a9 ) <62- ;R :71 -.— <br /> DATES <br /> EH 28 041 Revised 1/89 <br /> Administration Clinical Services Environmental Health Public Health Nursing <br /> 468-3400 468.3830 468-3420 468-3880 <br /> Air Pollution Community Services Laboratory WC <br /> 468-3470 468-3820 468-3460 468-3280 <br /> A;0S Information 468-3824 <br />