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j HOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> At Crow,Pres. San Joaquin County <br /> Earl Pimentel,Vice Pres. 1601 East Hazelton Avenue City of Manteca <br /> Tommy Joyce,Secy. Stockton, California 95205 City of Escalon <br /> j 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,O.V.M. ENVIRONMENTAL HEALTH DIVISION San Joaquin County <br /> j Daphne Shaw f 2C)9) 468-34 .0 City of Stockton <br /> Harvey Williams,Ph.D. San Joaquin County <br /> peU-rHCIFZ I Z AT I CIN TCI F, EL-EASE <br /> I <br /> - ANALYTICAL RESULTS <br /> GEOTECHNICAL DATA <br /> i <br />'I <br /> - ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I , THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT &00 -t,;7. ��t-h irl L1-ne Lodi ��aci lily Zo76 <br /> (STREET ADDRESS) (CITY) <br /> HEREBY AUTHORIZE 4,FPL-1 95,i0 4NA(-' V(-4k �1C1 Ul�'UAIFIE�tl�, Cl4X3G�f4�U12! t�S <br /> (LABORATORY or CONSULTANT) <br /> TO RELEASE ANY AND ALL ANALYTIC_:AL RESULTS, GEOTECHNICAL DATA AND/OR <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION TO THE SAN JOAQUIN LOCAL HEALTH <br /> DISTRICT AS SOON AS IT IS AVAILADLE AND AT THE SAME TIME IT IS PROVIDED <br /> TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: Aizc.o AM-il-FM WItw t MARK r <br /> (IF APPLICABLE) <br /> OWNER./OPERATOR: AP40 PWZPUCTS- Co- <br /> (PLEASE PRINT) (TITLE) <br /> X 7 <br /> SIGNRIURE) <br /> ADDRESS: _ 2000 ALAk/LERA, AS k2 PUL-'::�;,latS <br /> (NAILING ADDRESS) <br /> sAN IVLAT-Eo CA 54403 <br /> (CITY) (STRTE) (ZIP) <br /> PHONE: ( 41 S ) 571 -z4o o <br /> DATE: 1ii/Z I/4C, <br /> EH 23 041 Revised 1/89 <br /> Administration Clinical Servicos Environmental Health Public Health Nursing <br /> 468-3400 468-3830 468-3420 463-3860 <br /> Air Pollution Community Services Laboratory WIC <br /> 468-3470 468-3820 468-34GO 4G8-3280 <br />