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60A1W OF TRUSTEES SA JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> Al Crow,Pros. <br /> Earl Pimentel,Vice Pres. 1601 East Hazelton Avenue San Joaquin County <br /> Tommy Joyce,Secy. Stockton, California 95205 City of Manteca <br /> James F.Culbertson City of Escalon <br /> John D.Mask M.D. JOGI KHANNA, M.D., M.P.H., DISTRICT HEALTH OFFICER city of Lodi <br /> Virginia Mathews City of Tracy <br /> Thom"Schubert,D.V.M. ENVIRONMENTAL HEALTH DIVISIONCity of Ripon <br /> Daphne Shaw (209) 468-3424 San Joaquin County <br /> Harvey Williams,Ph.D. City of Stockton <br /> San Joaquin County <br /> A U T"O R I Z A T ION T O R E L E AaE <br /> -�+- ANALYTICAL RESULTS <br /> -M- GEOTECHNICAL DATA <br /> -�+ ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 530 E. Market st. Stockton Ca. <br /> (STREET ASIKESS) (CITY) <br /> HEREBY AUTHORIZE Roy F. Weston Labs <br /> (LABORATORY or CONSULTANT) <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. <br /> BUSINESS NAMES Stockton Record <br /> (If J?PLICABLE) <br /> OWNER/OPERATOR: <br /> l' ASE PRIM (TITLE) <br /> (S160ATURE) <br /> ADDRESS! 530 E. Market St. <br /> (NAILIN6 AIQRESS) <br /> Stockton Ca. 95202 <br /> (CITY) (STATE) (Ili') <br /> PHONE it S� > <br /> DATE: <br /> EH 23 041 Revised 1/83 7 <br /> Admini*a#on Clinical Services Environmental Health Public Health Nurairtg <br /> 488'3400 486-3830 488-3420 488-3880 <br /> Air Pollution Community Services Laboratory WIC <br /> 488-3470 488-3820 488-3480 488-3280 <br />