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BOARD OF TRUSTEES SAV7 JOACUIN LOCAL HEALTH DISTHICT <br /> SERVING <br /> A!Crow,Pres. San Joaquin County <br /> Earl Pimentel,Vice Pres. 1601 East Hazelton Avenue City of Manteca <br /> Tommy Joyce,Sec'y. Stockton, California 95205 City of Escalon <br /> James F.Culbertson City of Lodi <br /> John 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 �, Splaquin County <br /> Daphne Shaw C .,C),D 1 468-342 j �G q'y�of Stockton <br /> Harvey Williams,PhA S.D. an�agon County <br /> AU-rHC3FR I ZAT I C:)1\11 TO FZEILEA <br /> - <br /> ANALYTICAL RESULTS �.� � <br /> pZ' <br /> -#- <br /> GEOTECHNICAL DATA <br /> - - ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I , THE UNDERSIi3NED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 215 W. Main St Ripon <br /> (STREET ADDRESS) (CITY) <br /> HEREBY AUTHORIZE California Water Labs <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: N&S Irrigation <br /> (IF APPUCABLI) <br /> OWNER/OPERATOR,: Ed Nicolay Secretary <br /> (PLEASE PRINT) (TITLE) <br /> (SIGNATURE �— ' <br /> ADDRESS: p.o. BoY 805 <br /> (NAILING ADDRESS) <br /> Ripon CA 95366 _ <br /> (CITY) (STATE) (ZIP) <br /> PHONE: ( 209 ) 599-3456 <br /> DATE: May 18 , 1989 <br /> EH 223 041 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 468-3460 468-3280 <br /> AIDS Information 468-3820 <br />