Laserfiche WebLink
BOARD OF 1RUSTEES <br />James Culbertson. Pres. <br />Pefricls E. Vannuccl. Secy <br />Anthonalle Van Spronson <br />Earl Plmentel <br />Fern ©upbee <br />Daniel L. Flores <br />John 0, Mast. M.D. <br />William J. Wade <br />Mary Anna Love <br />• . -' � 9 <br />SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br />City of Lodi <br />1601 East Hazelton Avenue, P. O. Box 2009 <br />San Joaquin County <br />City of Escelon <br />Stockton, California 95201 <br />City of Maniacs <br />209/466-6781 <br />City of Ripon <br />City of Stockton <br />City of Tracy <br />Jopi Khanna, M.D.. M.P.H.. District Health Officer <br />San Joaquin County <br />San Joaquin County <br />AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br />SITE ASSESSMENT INFORMATION <br />I, the undersigned owner and/or operator of the property and/or facility <br />located at 260 E. Main Street, Manteca, CA <br />hereby authorize Canonie Environmental, Stockton, CA 983-1340 <br />to release any and all analytical results, geotechnical data and site <br />assessment information to the San Joaquin Local Health District as soon <br />as it is available and at the salve time it is provided to me or my <br />representative. <br />Owner/Operator: w^��;, �on Title <br />Address 530 Yale St -,Phone <br />San F anci co, CA 94134 <br />Date: <br />" no nr ljr1T 11 <br />Owner 6YeG <br />