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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVINO <br /> At Crow,Pres, San Joaquin County <br /> Earl Pimentei,Vice Pres, 1601 East Hazelton Avenue City of MCounty <br /> Tommy Joyce,Selly Stockton, California 95205 City of Eacalon <br /> James F.Culbertson City of Lodi <br /> John D.Most.M.D, 4001 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 Sen Joaquin County <br /> Daphne Shaw (209) 468-3420 City of Stockton, <br /> Harvey Wills Ph.D. San Joaquin County <br /> AUTHOR I ZAT I ON 'P© REL-MASE <br /> q+ ANALYTICAL RESULTS <br /> at• GEOTECHNICAL DATA "1 <br /> -W ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> Ir THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATE AT 1990 E . Yosemite Avenue Manteca A <br /> (SIRES► APPRESS) (CITY) t 4' <br /> HEREBY AUTHORIZE�4merican Environmental Management Corporation <br /> (LA80947ORy or CONSKIAN/) <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 15 PROVIDED <br /> TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: Manteca Trailer & Camper , Inc. <br /> (IF AN(ICAAU) <br /> OWNER/OPERATOR, Bob Davis Owner <br /> (P(EASE PAIN ) UITLE 4 <br /> 4u F. t <br /> (SfARA1U <br /> ADDRESS, P .O. Box 2036 t. <br /> (AA/(INA ADDRESS) <br /> Manteca , CA 95336 <br /> WIN (SIAIE) (ZIP) <br /> PHONE: ( 209) 239-1267 S! <br /> DATE: " + <br /> EH 23 041 Revised 1/89 P <br /> Administration Clinical Services Environmental Health Public Health Nuraing'4 <br /> 188.5400 486.3890 488.3420 468.3050 <br /> Ale Pollution Community Services Laboratory WIC <br /> 469•0470 465.31120 468.3460 fan-3200'°, <br />