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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> Al Craw,Pres. SERVING <br /> Tommy <br /> Earl y Joyel,vice rias. 1601 East Hazellon Avenue San Joaquin County <br /> Secy. Stockton, <br /> James F,.Culbertson California 95205 City of Manteca <br /> John D.Mast,M.D. City of Escalon <br /> JOG) KHANMA, M.U., M.P.H., DISTRICT HEALTH OFFICER City of Lodi <br /> Virginia Mathews <br /> Thomas Schubert,Q.V.M. City of Tracy <br /> Daphne Shaw ENVIRONMENTAL HEALTH DIVISION City of Ripon <br /> Harvey Williams,Ph.D. (2'09) 4 G e—3 4 2,0 San Joaquin County <br /> City of Stockton <br /> A U T H Q Ei I Z A—r— I C31q -r San Joaquin County <br /> E�E:EL.E:A E3 E <br /> - ANALYTICAL RESULTS <br /> - - GEOTECHNICAL DATA <br /> a* ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 4546 N. Wilson Way, Stockton, CA <br /> (STREET ADDRESS) (CITY) <br /> HEREBY AUTHORIZE McLaren Environmental Engineering <br /> (080RAIORY or xS <br /> TO RELEASE ANY AND ALL ANALYTICAL RESULTS, GEOTECHNICAL DATA AND/OR <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION TO THE SAN JOAMUIN 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: ✓ - f c <br /> (IF APPLICABLE) <br /> OWNER/OPERATOR: <br /> /- <br /> (PLEASE PRINT) (Tl [E) <br /> f S l6NAT!!RE) <br /> ADDRESS: <br /> (HARING ADDRESS) <br /> o95-2 a <br /> (City) (STATE) (IIP) <br /> PHONE: <br /> DATE: <br /> EH 23 041 Revi sed i/89 <br /> Administration Clinical Services <br /> 468-3400 Environmental Health Public Health Nursing <br /> 468-3830 468-3420 <br /> Air Pollution 468-3860 <br /> Community Services Laboratory <br /> -" - <br /> 468-3870 468-3820 WIC <br /> 468-3460 468-3280 <br /> AIDS Information 468-3820 <br />