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BOARD OF TRUSTEES SAY.�OAQUIN LOCAL HEALTH DISYICT SERVING <br /> Al Crow,Pres. San Joaquin County <br /> Earl Plmentel,Vice Pres 1601 East Hazelton Avenue <br /> City of Manteca <br /> Tommy Joyce,Sec'y. Stockton, California 95205 City Escalon t� <br /> James F.Culbertson City of,Ladl <br /> John D.Mast,M.D. ! JOGI KHANNA, M.D., M.P.H., DISTRICT HEALTH OFFICER City of Tracy <br /> Virginia Mathews iM jM City of Ripon �. <br /> Thomas Schubert,D.V.M. ENVIRONMENTAL HEALTH DIVISION San Joaquin Count' <br /> Daphne Shaw (209) 468-3420 City of Stockton <br /> Harvey Williams,Ph.D. San Joaquin County ; i <br /> AU-r ED FR I ZAT I 113 P41 TCI MELEAE3E s <br /> ! if <br /> "011- ANALYTICAL RESULTS <br /> - GIEOTECHNI�I CAL DATA <br /> -�- ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER, AND/OR OPERATOR, OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT r` 1 <br /> (ST EE1 ADDRESS) I �� fCIr ;{ <br /> HEREBY AUTHORIZE f. ! ►'} [_"o Cr >- ! fi <br /> (LABDRAI4Rl or CDNSIJLTANI)' <br /> TO RELEASE ANY AND ALL ANALYTICAL RESULTS, GEOTECHNICAL DATA AND/OR , <br /> ii <br /> ENVIP,ONMENTAL/SITE ASSESSMENT INFORMATION TO THE SAN JOAQUIN LOCAL HEALTH <br /> i <br /> DISTRICT AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED. �z �l <br /> TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: e ! ` <br /> (IF APPLICABLE) II <br /> OWNER/OPERATOR: Senlcr Z21gir%irt AEQQ j19 u r <br /> (P SE IN[) '` (1ITLE) f: <br /> (S RARE) 13 <br /> ADDRESS: A C. Z-3 ox 4 cv.2'31 <br /> (RAILIN6 ADDRESS) <br /> 411 <br /> Car) mr cl4 52-4- <br /> (City) <br /> (City) i! (SLATE) flip) <br /> PHONE: (415) <br /> DATE: AC4 u�� 10l <br /> EH 23 041 Revi sL-d i/fly � • ;4 i <br /> Administration Clinical Services Environmental Health Public'Health Nursing <br /> 468-3400 468-3830 468-3420 468-3860 <br /> Air Pollution Community`Services Laboratory WIC <br /> 468-3470 468-3820 468-3460 468-3280 <br /> ;II AIDS Information 468-3820 I. <br />