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BOAH.E1 OF'TRUSTEES SAIIOAQUIN LOCAL HEALTH D1S*T <br /> Al Crow,Pres. 'SERVING <br /> Earl Pimentel,Vice Pres. 1601 EaSI Hazelton Avenue San Joaquin County <br /> Tommy,Joyce,Selly. <br /> James F.Culbertson• Stockton, California 95205 City of WAnleca John D.MasClfy of Escaloro <br /> Mask ws JOG( "ANNA, M.D., fii.AM, DISTRICT HEALTH OFFli:ER Cuy Of Lodi <br /> Virginia Mathews City Thomas Schubert,[).VM. ty Of T.M. ENVIRONMENTAL HEALTH DIVISION C 01 Rip acy <br /> Daphne Whew �209) 4S$_04`0 Son Joaquin County <br /> Harvey willisms,PhD. City of Stocklon <br /> AUTHOR x ZAT' I ON TO RELEASE San Joaquin County <br /> -� ANALYTICAL RESULTS <br /> -*F GEOTECHNICAL DATA <br /> -�- ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I , THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AMD/OR FACILITY <br /> LOCATED AT 4945 Waterloo Rd. Stockton, CA 95205 <br /> (STREET nPRESS) 11 <br /> HEREBY AUTHORIZE California Water Lab A92to, CA <br /> TCI 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 /> FOUSINESS NAME: F & H Construction <br /> (if VILICABLE) <br /> OWNER/OPERATOR: <br /> iE1SE 1 f11TLE) <br /> fS16Y EIRE) <br /> ADDRESS: 4945 Waterloo Rd. <br /> (SAIL U6 490RESS) <br /> Stockton, CA 95205 <br /> (CITY) f 51410 <br /> PHONE: ( 209 931-3738 <br /> DATE: C6-- <br /> EH <br /> 6- -EH 23 041 Revised 1/89 <br /> Administration Clinical Services Environmental Health <br /> 468-3400 468-31330168-3120 4fi8-3660'Public Health Nursing <br /> Air Pollution Community Services Laboratory <br /> 468-3470 488-38 WIC <br /> 468-3460 468-3280 <br /> AIDS Intormetion 46A-3A20 <br />