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SITE INFORMATION AND CORRESPONDENCE FILE 2
Environmental Health - Public
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EHD Program Facility Records by Street Name
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E
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103
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3500 - Local Oversight Program
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PR0544638
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SITE INFORMATION AND CORRESPONDENCE FILE 2
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Last modified
8/16/2019 11:14:41 PM
Creation date
7/9/2019 1:34:01 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
SITE INFORMATION AND CORRESPONDENCE
FileName_PostFix
FILE 2
RECORD_ID
PR0544638
PE
3528
FACILITY_ID
FA0004027
FACILITY_NAME
HENDRIX FORK LIFT INC
STREET_NUMBER
103
Direction
N
STREET_NAME
E
STREET_TYPE
ST
City
STOCKTON
Zip
95205
APN
15318001
CURRENT_STATUS
02
SITE_LOCATION
103 N E ST
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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EHD - Public
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a /.�.�C JVh1JUut" L.VLHk_ tILAL-11b <br /> Wb«1ssw �vre.kSEftYING <br /> «.,, h«. < 1601 East Hat' Aymu�.P.O.Bac 2 C* <br /> 014 <br /> E.,f�� � Stockton.Ca(Hore�la 95201 '����,c.�Mr <br /> Walnl�MNMr.y :ci 1 4..6caka <br /> 0{M.1 L f law (209) 444.4?61 h.M liff�+e.e. <br /> _ _ <br /> i.tiad►aw J*#Xh. 1A6 M b% 1.f jf..ObMd 11edili"Oft« . .Ckr'if-stocuuen <br /> "144 rwwntr <br /> AUT!{OitIZATION TO RELEASE ANALYTICAL RESULTS. GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION J <br /> 1 <br /> I , the uwdereigaed owner and/or operator of the <br /> located at /a3 . ''L '� property and/or ff.acility. ; <br /> hereby authorize � L <br /> Co release Kay and all analytical' results, geotechnical- data and sites <br /> assessment information to the San Joaquin. Local Elealth District as soon <br /> F as it is <br /> available and at the same time it is provided to me or my <br /> fpresentative, i <br /> Owner/Operator: X• �1c� Z 1 4 5�� � <br /> 'Citic: � <br /> Add res,,; Phone 1?jjL77P-�r2_j_ <br /> EH 08 OS UGT 13 t <br /> i� ' t ;•..-.�.,•y ;•'.aY.-i" •' �s. �a 1..1d:r r � a r. : �' <br /> Ilk <br />
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