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• 51OAAD of: 'RUSTER41 SAN JOAQUIN LOCAL HEALTH DI$T ICT SERVING <br /> Al Crow,Pres. San JoaQuin County <br /> Earl Plmentol,Vice Pres, t 601 East Hazelton Avenue City of Mant8C0 <br /> Tommy Joyce,Secy, Stockton,Cali(ornla 85zo5 City of Escalon <br /> James F.Culbertson City of Lodi <br /> John D.Mast,M.O. JOG1 KHANNA. M.O., M.P.H., DISTRICT HEALTH OFFICER City of Tracy <br /> Virginia Mathews City of Ripon <br /> Thomas Schubert D.V.M. ENVIRONMENTAL HEALTH DIVISION San Joaquin County <br /> Daphne Show (20S) 468-3420 city car Stockton <br /> Harvey Williams,Ph.D. San Joaquin County <br /> ^UT!-IOFB I Z^T" I ON T"O F;ZeL-EEASE <br /> +1111- ANALYTICAL RESULTS <br /> -Ice- GEOTECHNICAL DATA <br /> -f✓~- <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I , THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 2855 Cam2us Drivc, Suite 300 San Mateo, California <br /> (STREET ADDRESS) (CITY) <br /> HEREBY AUTHORIZE Earth Metrics Incorporated <br /> (LABORATORY or CONSFLTANT) <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: SILVA BROS. DAIRY <br /> (IF APPUCARI) <br /> OWNER/OPERATOR: SILVA BROS, a Partnershi owners <br /> (PLEASE PRINT) (TITLE) <br /> BY: 2 <br /> SIiNA1DRE) <br /> ADDRESSs 7317 W. GRANTLINE RD. <br /> (NAILINi ADDRESS) <br /> TRACY, CALIF. 95376 <br /> (CITY) (STATE) (IIP) <br /> PHONEt (09 ) 835-7316 - <br /> DATE: MAY 15, 1989 <br /> EH 23 041 Revised 1/89 <br /> Administration Clinical Services Environmental Health PUCIIC Health Nursing <br /> 468-3400 468.3630 468-3420 468-3860 <br /> Air Pollution Community Services Laboratory WIC <br /> 468-3470 488.3820 468-3460 488.3280 <br /> AIDS Information 488-3820 <br /> nrr, firiFZnQ CT1 UT — fi—PPF. I <br />