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r <br /> z SA -✓jOAOUIN LOCAL HEALTH{ DISI T SERVINGW4 vice Pres. 1601 East Hazelton Avenue San Joaquin Count <br /> rimy JoyCe,Sec'y- Stockton, California 95205 City at Manteca <br /> Cit of Eacalon <br /> James F.Culbertson 1 �k - � Cit of l.odl <br /> John D.Mast,M.D. JOGI KHANNA. M.D., M-P-N., DISTRICT HEALTH OFFICER Cit of Tracy <br /> Virginia Mathews 11 1� City of Ripon <br /> Thomas Schubert;D.V.M. ENVIRONMENTAL HEALTH DIVISION San.Joaquin County <br /> Daphne Shaw (209) 468--3420 City of Stockton <br /> Harvey Williams.PhD. Sen Joaquin County <br /> AU-rH©F;Z I ZAT 100 T[] #F;ZEILEAE3E <br /> M <br /> ANALYTICAL RESULTS E <br /> -�- GEOTECHNICAL DATA ' <br /> f -W ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I , THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/Ofd FACILITY <br /> LOCATED AT 880 Beckman Road I;Lod4 <br /> (SIREET ADDRESS) (Cllr) <br /> HEREBY AUTHORIZE Condor Earth Technologies In'c . <br /> (LABORATORY or CONSULTANT) <br /> TO RELEASE ANY AND ALL ANALYTICAL RESULTS, GEOTECHNICAL DATA AND/DR <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: J . I . Case Corporation <br /> (1F HPLICABLE) <br /> OWNER/OPERATOR: .W .T . Becker <br /> (TLE E PRINT) - (TITLE) <br /> l <br /> (S16141URE) I I <br /> r <br /> ADDRESS: -700 State Street ;P <br /> flf4lilNti ADDRESS) _ '� ' <br /> Racine WI 53404 <br /> (City) (S1410 (Z1?) <br /> PHONE: f 414 ) 636-601 <br /> DATE: 3 <br /> EH 23 041 Rev sed 1/89 f <br /> f p <br /> Administration Clinical Servicos Environmental Haolth Public Hoalth Nursing <br /> 468-3400 466-9830 468-',3420 if 465-3860 <br /> Air Pollution Community Services Laboratory WIC <br /> 468-3470 468.3820 468-3460 4G8-azaa <br /> AIDS information 468-3820 �� <br />