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gay ' �" <br /> BOARD OF.TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT sERVINt3 <br /> At Crow,Pres. <br /> EarFPlmenlal,vice Prot. 1601 East Hazelion Avenue Sen Joaquin County <br /> Tommy Joyce,Sac'y. Stockton,Calllornia 95205 City or Maniacs <br /> Jame$F.Culberl$oq City of Esealon <br /> Jchn D,Maes,MD. J0011 KHANNA, M.D.,M.P.H., DISTRICT HEALTH OFFICER Cllyol Lodi <br /> MrClnle Mathews City of Trecy <br /> ThemalL Schubert,D.V.M. ENVIRONMENTAL HEALTH DIVISIONCity of Ripon <br /> Daphne Shaw San Joaquin County <br /> Hervey Williams,PhD, (209) 468-3420 City of Slocklon <br /> San Joaquin County <br /> AUTW®R x ZA-r I ON _rO R'ML_aAE3E <br /> ANALYTICAL RESULTS <br /> - GEOTECHNICAL DATA <br /> ENVIRDNMENTAL/SITE ASSESSMt" INFORMAT.ON <br /> # I, THE UNDERSIGNED OWNER AND/13R OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 959 Moffat Boulevard, Manteca, CA <br /> 1 rsr�rrl A��AEss) <br /> HEREBY AUTHORIZE EEnvironmental, Stockton,(C1 (209) 942-0181 <br /> (tAsort,rl6lr ar t:o!lSlrcrflAll ' <br /> a TO RELEASE ANY AND ;LL ANALYTICAL RESULTS, GEOTECHNICAL DATA AND/OR <br /> ENVIRONMENTAL/SITE A:95ESSMENT INFORMATION TO THE SAN JOAQUIN LOCAL HEALTH <br /> DISTRICT AS SOON AS IT IS AVAILABLE AND AT THE SANTE TIME IT IS PROVIDED <br /> € TO ME OR MY REPRESENTATIVE. <br /> Raymond Investment[OWNER/OPERATORe <br /> NESS NAME$ Y e t Corporation <br /> JAJUA <br /> (If APPcteaaaEl <br /> r <br /> I <br /> (P EASE P11111 frdrrE) <br /> t � <br /> St SANK) <br /> ADDRIESS: <br /> ("IL111 APPIESS) <br /> � «Irr) <br /> A (SIRE) (IIP) <br /> PHONEt b y a <br /> ' ---- - -- <br /> DATE:---- r. 4 <br /> '14 23 041 Revised 1/89 <br /> Administration Clinical Servlces Envlronmeniat Health } <br /> 468.3400 486-38� Pubtic Health Nursing } <br /> 458-3420 488.3800 I <br /> �. Atr Polfvlla" Community Services Laboratory <br /> 48tMC <br /> 8.3410 468.3820 466-3460 4811.3200 ` <br /> d AIDS Infarmsiton 468.3820 <br />