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BOARD OF TRUSTEES SA,. JOAQUIN LOCAL HEALTH (DIST.q!rT <br /> .% <br /> AI Crow,P,,= SERVING <br /> Earlel,vice Pres <br /> Tommyy Joyce, 1601 East Hazelton Avenue Sen Joaquin Count/ <br /> ce,Selly, Stockton, California 95205 Cit'of Manteca <br /> • <br /> James F.Culbertson <br /> John D.Mast, City of Escnlon <br /> JOGI KHANNA M.D. City of Lodi <br /> Virginia Mathews <br /> wa � � M.P.H., DISTRICT HEALTH OFFICER <br /> Thomas Schubert,D.V.M. City of Tracy <br /> Daphne Shaw ENVIRONMENTAL HEALTH D 1 V I S Y ON City of Ripon <br /> Harvey Wiillams,Ph.D. (200) 460-34;:t) San Joaquin County <br /> City of Stockton <br /> A U T H O Fti I Z A T I CJ tyTO 1' zELEAf3E <br /> San Joaquin County <br /> - ANALYTICAL RESULTS <br /> -+f- <br /> GEOTECHNICAL DATA <br /> - - ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I , THE UNDERSIGNED OWNER AND/OP, OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 25775 S. Patterson Pass Road 'P-- <br /> --- <br /> (S71111 ADDRESS) (Gill) <br /> HEREBY AUTHORIZE Anametrix Inc. San Jose lab. or R <br /> oux <br /> TO RELEASE ANY AND ALL ANALYTICALNSRESULTS, GEOTECHNICAL DATA AND/OR consultant) <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: ARCO Facilit 61 <br /> nn <br /> (If APPLICABLE) <br /> OWNER/OPERATOR: <br /> l[ASE PRINT) (III LEI <br /> left-c—Cmiel S 7-1 Cr Fit) <br /> (SIGNAIUAf1 'A-t>� ti' <br /> ADDRESS: 2000 Alameda de las Pulgas <br /> (NAILING ADDRESS) <br /> San Mateo <br /> (CIII) (SI AIF) rll�l <br /> PHONE: ( 415 ) 571-2400 <br /> AA MO <br /> DATE: 5—� � �� rNVif?pN <br /> PERMIT/SERVICES LTtJ <br /> EH tS 041 Revised 1/0`� <br /> Administration Clinical Services <br /> 460.0400460-0000 Environmental lioa:Ih Public Hoailh Nursing <br /> 4GO-0420 <br /> Air Pollution460-0060 <br /> Community Services Unboratory <br /> 460-0020 <br /> 4G0-0470 WIC <br /> 460.04G0 460.0200 <br />