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80APr*OF Tr!JSTES SAM OWNLOCAL HEM.7H DISTRICTSERVING <br /> 0San Joaquin County <br /> t"ro�r,"res. 1601 East Hazelton Avenue City of Manteca <br /> Earl P+ ^enteB,Vice Pres. <br /> Stockton,California 95205 City of Escalon <br /> : ''.. :I�rtron City of Lodi <br /> Jame <br /> FFICER City of Tracy <br /> John a.Mast,M.D. JOGI KHRANNA, M.D., M.P.H., DISTRICT HEALTH O <br /> Virginia Maihews City of Ripon <br /> Thomas Schubert.D.V.M. ENVIRONMENTAL HEALTH DIVISION San Joaquin County <br /> Daphne Shaw (2 9) 4G8-3420 City of Stockton <br /> Harvoy, Williemm,Ph.D. San Joaquin County <br /> -�- ANALYTICAL RESULTS <br /> -art- <br /> GEOTECHNICAL DATA <br /> -TM°- ENV'^ONMrNTAL/SITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER. AND/OR OPERATOR OF THE PROPERTY AND/OR r-AGILITY <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 /> ENV'R0NM7NTAL/P1TE ASSESSMENT INFORMATTON TO THE SAN JOAQUIN LOCAL HEALTH <br /> O'.GTRTA- e'-S SOON AS TT IS AVAILABLE AND AT THE SAME TIME IT IF, F'F:nVIDED <br /> TO ME CR MY RTORESENTAT`VE. <br /> `PUST'�''"nG NAME: N&S Irrigation <br /> (If APPLICABLE) <br /> OWNER/OPERATOR: Ed Nicolay Secretary <br /> (PLEASE PRINT) (TITLE) <br /> AI mi4rlo <br /> (SI6NPJ RE � <br /> ADDRESS: P.O. ox 8Q5 <br /> (NAILIN; ADOKSS) <br /> Ripon CA 95366 <br /> tiCITY1 (STATE) (IIP) <br /> PHONE: —( ?,Q9) 599-3,456 <br /> DATE! May 18, 1989 <br /> EH 22 0411"_ Revised 1/89 <br /> Administration Clinical Services Environmental Health Public Health Nursing <br /> 468-'400 468-3830 468-3420 468-3860 <br /> ",Ir Pollution unity Services Laboratory WfC <br /> °fa•" 70 Co6159-3820 460-3460 468-3280 <br /> AMS Information X58-2820 <br />