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BOARD rRusTF.Es <br /> AjCrow.Pres. SA"' IS <br /> JOAQUIN LOCAL HEALTH D ' � `r`T - <br /> ' wPr � SERVING +� <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 Gy of Escalon <br /> John D Mast,M D JOGI KHANNA, M.D, IW,p H,� DISTRICT HEALTH OFFICER City of Lodi <br /> Virginia Mathdwe Gy of Tracy <br /> Thomas Schubert D V M <br /> Daphne Shaw ENVIRONMENTAL HEALTH DIVISION City of Ripon <br /> ' (209) 468-34-20 San Joaquin County <br /> Williams,Ph D City of Stockton <br /> • San Joaquin County <br /> AUTHOR I ZA'T I ©N Tp �EL..EAS3E <br /> - ANALYTICAL RESULTS <br /> - GEOTECHNICAL DATA <br /> ' - ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I , THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OP. FACILITY <br /> LOCATED AT 248 E. KetfIeman Lane Lodi , CA <br /> ' (S)REEf ADDRESS) Cllr) <br /> HEREBY AUTHORIZE California Water Lab Modesto, CA <br /> (L#80 ATORY or <br /> ULA8I <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 NAME: Geweke RV <br /> 71OWNER/CPERATOR: <br /> Dar l Geweke <br /> Owner/Operator <br /> (KE sb-Attill"11 <br /> rstsxAr�tAE-Y�� <br /> ADDRESS: P, p, Box 3.21.0 <br /> ("IL Ili ADDRESS) <br /> Lodi cA 95241 <br /> (crrr) (STATE) (ZIP) <br /> PHONE: C ) _ D <br /> 1 <br /> DATE: November 8, 19$9 <br /> EH 23 041 Revised 1/89 <br /> 10 <br /> Administration Clinical Services <br /> ' 468-3400 46a-3830 Environmental Health Public Health Nursing 468-34200 Air Pollution 468-3830 <br /> 4sa 3470 <br /> Community Services Laboratory <br /> 468-3820 WIC <br /> 46e-3460 468-3280 <br /> ' AIDS Information 48A-31120 <br />