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eOARD OF TRUSTEES SAN Naive <br /> LOCAL HEALTH DISTRICT <br /> N Crow,Prea. SERVING <br /> Earl Pimentel,Vice Pres, 1601 East Hazelton Avenue San Joaquin County <br /> Tommy Joyce,Selly. Stockton,California 95205 City or Manteca <br /> James F.Culbertson City of Escalon <br /> John D.Mast,M.D. JOGI KHANNA, M.D., M.P.H., DISTRICT HEALTH OFFICER City of Lodi <br /> Virginia Mathews City of Tracy <br /> Thomas Schubert D.V.M. ENVIRONMENTAL HEALTH DIVISION City of Ripon <br /> Daphne Shaw C 209) 4613-3420 San Joaquin County <br /> Harvey Williams,PhD. City of Stockton <br /> San Joaquin County <br /> A LJ T N O R I Z A T I O N -11-0 R E L E A S E <br /> ANALYTICAL RESULTS <br /> GEOTECHNICAL DATA <br /> 4>t ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> Ir THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT �/ j 7 ��•� �/� ' c ��''c' ��� <br /> (SJrEEI 111AEjS) (City). <br /> HEREBY AUTHORIZE__ 6Y F. LQ&,TO N <br /> (1NOAIJOAy or CONSILIANr) <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.�� I <br /> BUSINESS NAMES _ iJ <br /> / /(IF/AIIIICNUI (J ! / /J <br /> OWNER/OPERATOR: 1`. J , / �r 2+�z c - C- <br /> (PLEASE Pill!! (11/lf) vvv r <br /> /�rstNi►IAf) <br /> ADDRESS: ,t` r /;- )"I j� c lC <br /> _ (/#11116 NiAESS1 / �^ <br /> (City) lS1/ff) (f1P) <br /> PHONEe <br /> DATE: ,--�) <br /> c <br /> EH 23 041 Revised 1/83 <br /> Administration Clinical Services Environmental Health <br /> 488-3400 468.3630Public Health Nursing <br /> Nr 8-34 Community services <br /> 168-31700 Laboratory 468-3420 468-3860 <br /> 486-3620 WIC <br /> 468.3460 468-3280 <br />