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BOARD OF TRUSTEES SAN -"AQUIN LOCAL HEALTH DISTP"'T SERVING <br /> At Crow,Pros. Son Joaquin County <br /> Earl Pimonlol,Vico Pres. 1601 East Hazelton Avenue City of Manteca <br /> Tommy Joyce,Soc'y. Stockton, California 95205 City of Escalon <br /> Jomos F.Culbertson City of Lodi <br /> John 0.Mast,M.D. JOGI KHANNA, M.D., M.P.II., DISTRICT HEALTH OFFICER City of Tracy <br /> Vlrginlo Mathews City of Ripon <br /> Thomas Schubert D.V.M. ENVIRONMENTAL HEALTH DIVISION San Joaquin County <br /> Daphne Shaw (2,,C)9) 466-3420 City of Slocklon <br /> Harvey Williams,Ph.D. <br /> San Joaquin County <br /> rPa U T H CD Fc D1 Z rte+T 2 CD N -I CD F'E L_L A, 8 FEE <br /> ANALYTICAL RESULTS <br /> GEOTECHNICAL DATA <br /> - ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> 1 , THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OP FACILITY <br /> LOCATED AT 1711 E. Yosemite Ave. , Manteca, CA <br /> (STREET ADDRESS) (CITY) <br /> HEREBY AUTHORIZE 4WIie4 de�>isfemS <br /> (LABORATORY or CONSULTANT) <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 PF'OVIDE=D <br /> TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME• ARCO Facility # 6020 <br /> IIF APPLICABLE) <br /> OWNER,/OPERATOR: x�zi P chri sti P for ARCO Products Company Environmental Engineer <br /> (PLEA.SE PRINT) (TITLE) <br /> - - - <br /> f S16NATUF.E) <br /> ADDRESS: 2000 Alameda de lAs Pulgas <br /> (NAILING ADDRESS) <br /> San Mateo, CA 94403 <br /> (CITY) (STATE) (ZIP) <br /> PHONE: ( 415 ) 571-2400 <br /> DATE:,f II/?-(mo I <br /> EH 2-0 041 Revised 1 /Q9 <br /> Adminis'.rellon Clinical Servicos Envlronmontal lioo:th Public, Hoalth Nursing <br /> 468-3400 468-3830 468-3420 463.38GO <br /> Air Pollution Community Services Lnborotory VVIC <br /> 460-3470 468.3820 408-3400 468.3200 <br />