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BOARD OFjTRUSTED SAW JOAQUIN LOCAL HEALTH DIS*ICT SERVING <br /> County <br /> am PMWW*91 VIM Pros. 1601 East Hazelton Avenue s.n�ofMantoca <br /> Tommy Joyos.Seo'y. Stockton,California 95205 City of Escalon <br /> Jamfis F.CtAbertson City of Lodi <br /> John D.Mast,M.D. JOGI KHANNA, M.D., M.P.H., DISTRICT HEALTH OFFICER City of Tracy <br /> Flipon <br /> ThomasSdudwt.0M.M. ENVIRONMENTAL HEALTH DIVISION � \ San Joaquin�Co <br /> Thr <br /> Daphne Shaw (209) 468-3420 a City of Stockton <br /> Harvey Williams,PhD. San Joaquin County <br /> AUTHOM I ZA'T I ON TO iREL,.f---A8 <br /> J <br /> tet- <br /> ANALYTICAL RESULTS C � <br /> j <br /> OEOTECHN I CAL DATA <br /> i+- ENVIRONMENTAL/SITE ASSESSMENT INFORMA'T'ION <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 173D0.'.h} Road, Clements ,Ca 95227 <br /> (STREET AIORESS) (Cllr) <br /> HEREBY AUTHORIZE_ Canonie EnyixoU=ntg <br /> (LABORATORY or CONSNLIANI) <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 /> { <br /> BUSINESS NAME: Claude C. Wood Co. <br /> (IF APPLICABLE) <br /> OWNER/OPERATOR: Represenative— Dave Harrald Vice—President/Aggregates <br /> (PLEASE PRINT) (TITLE) <br /> (s1sNArbR <br /> ADDRESS: P 0 Box 599 <br /> (NAILING ADDRESS) <br /> T,nd j , CA 95241 <br /> (CITY) (STATE) (ZIP) <br /> PHONE: t 209 ) 334-0790 <br /> DATE: August 22,1989 <br /> EH 23 041 Revised 1/89 <br /> Administration Clinical Services Environmental Health Public Health Nursing <br /> 468-3400 488-3830 468-3420 468.3880 <br /> Air Pollution Community Services laboratory WIC <br /> 468.3470 468.3820 488-3460 468-3280 <br /> AIDS information 468-3820 <br />