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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> Al Crow,Pres. <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.Mast,M.D. City of Lodi <br /> JOG( KHANNA, M.D., M.P.H., DISTRICT HEALTH OFFICER City of Tracy <br /> Virginia Mathews <br /> ^ i <br /> Thomas Schubert,D.V.M. ENVIRONMENTAL HEALTH DIVISION 3 : 6 €, �y Pon <br /> a i� un <br /> Daphne Shaw (2 09) 458-3421:1 � � � t`''� t ty <br /> Harvey Williams,Ph.D. p iv J� San Joaquin(ounty <br /> AUTHOR I ZAT I ON TO FR FE R 01 1989 <br /> -W ANALYTICAL RESULTS <br /> CNVIRCNfJENTAL HEALTH <br /> - - <br /> GEOTECHNICAL DATA PERMIT/SERVICES <br /> -�- ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I , THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT_83,9 F- Mok(:lurnne Woodbrige, CA <br /> (STREET ADDRESS) (Citi') <br /> HEREBY AUTHORIZE G.H.H. Engineering, Inc. <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 OF MY REPRESENTATIVE. <br /> BUSINESS NAME: California Fuels <br /> (IF APPLICABLE) <br /> OWNER/OPERATOR: _Dave Atwater Owner <br /> (PLEASE PRI I) (TITLE) <br /> (SIGNATURE) <br /> ADDRESS: P.O. Bot: 1207 <br /> (NAILING ADDRESS) <br /> Stockton CA. 95201 <br /> (CITY) (STATE) (ZIP) <br /> PHONE: ( 209 ) 466-5921 <br /> DATE: <br /> EH 23 041 Revised 1/89 <br /> Administration Clinical Services Environmental Health Public Health Nursing <br /> 468-3400 468-3830 468-3420 468-3860 <br /> Air Pollution Community Services Laboratory WIC <br /> 468-3470 468-3820 468-3460 468-3280 <br /> AIDS Information 468-3820 <br />