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Sc�AA -;OF`TRUSTEES SAF JOAQUIN LOCAL HEALTH DIS RICT sERvlrrc <br /> 'A%!C,ow.Pres. <br /> �� San Joaquin County <br /> °`Earl Pimentel,Vice Pres. 1601 East Hazelton Avenue r City of Manteca <br /> Tommy Joyce,Secy. Stockton, California 95205 i City of Escalon <br /> 'James F.Culbertson ;{ City of Lodi <br /> John 0.Mast,M.D. JOGI KHANNA, M.D., M.P.H., DISTRICT HEALTH OFFICER City of Tracy <br /> ' Virginia Mathews i City of Ripon <br /> Thomas Schubert,D.V.M. ENVIRONMENTAL HEALTH DIV I S ICONSan Joaquin County <br /> Daphne Shaw (209) 468-3420 � E City of Stockton <br /> Harvey Williams PhD. 'I San Joaquin County <br /> AU-r"C7F;Z I Z AT ION -r C3 SEL 1. AE3I=— <br /> ANALYTICAL <br /> ANALYTICAL RESU L�TS <br /> - GEOTECHNICAL DATA <br /> ENVIRONMENTAL/SITE ASSESSMENT IiNFORMATION <br /> Ir THE UNDERSIGNED OWNED AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY � <br /> i' <br /> LOCATED AT �3 D WG /2 ' 7 pfd Ck rG JU <br /> (STREET ADDRESS) ITY)1, <br /> HEREBY AUTHORIZE O )']7�c '� /L)1?7"J o i� I�L /�S d u/7" rv%]� <br /> 'e (LABORATORY or CONSDLTANT) ! <br /> TO RELEASE ANY AND ALL ANALYTICAL RESULTS, GEOTECHNICAL DATA AND/OR <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION TOTHE SAN JOAQUIN LOCAL HEALTH <br /> ;j <br /> DISTRICT AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED <br /> TO ME OR MY REPRESENTATIVE. I i <br /> { If <br /> BUSINESS NAME: ?-k7)- <br /> (!F APPLICABLE) j <br /> .l <br /> OWNER/OPERATOR: a ,�E L <br /> IDLE SE PR! T) (TITLE) �I, <br /> (Sl6NA111RE) � <br /> is <br /> ADDRESS: I3 W ' .S l <br /> .(NAILING ADDRESS) <br /> t <br /> (CITY) (STALE) �� IlIP)'I <br /> PHONE: <br /> a + r <br /> DATE: p <br /> / 8 !J 2 L�2 - 1989 <br /> EH `O 041 Revised 1/89 <br /> L 1HEALiH <br /> Administration Clinical Services Environmental Health Public Health Nursing <br /> 468-3400 468-3830 468-3420 '1` 469-3960 <br /> 1 Air Pollution Community Services Laboratory; WIC <br /> { 468-3470 468-3820 468-3460 468-3280 <br /> 3,Y <br /> AIDS Information 468-3820 <br />