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1IOARD of TRUSTEES 4AN ,JOAQUIN LOCAL HEALTH DISTRIq <br /> Al Crow,Pres. , SERVING <br /> Earl Plmenlet,Vice Pres. 1601 East Hazelton A <br /> Tommy Joyce.Secy. venue { <br /> San Joaquin County <br /> James F Culbertson Stockton, California 95205 City of Manteca <br /> John D.Maar,M.D. City of Escalon <br /> Virginia Malhewa JOGI KHANNA. A4.0., MAIL, DISTRICT HEALTH OFFICER Cly of Lodi <br /> Thomas Schubert,D.V.M. City of Tracy <br /> Daphne Shaw ENVIRONMENTAL HEALTH DIVISION City of Ripon <br /> Harvey Williams,Ph.D. (2[x9) 469-3420 San Joaquin County <br /> Cly of Stockton <br /> A U T H OF-Z I Z A T I O INjTO San Joaquin County <br /> RELtEASt�. <br /> �+- ANALYTICAL RESULTS <br /> GEOTECHNICAL DATA <br /> -+� ENVIRONMENTAL/SITE ASSESSMENT INFORMATION4 <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PRDPEP. <br /> _ TY AND/OP. FACILITY <br /> LOCATED AT S L- 1r <br /> fSllt£ ADS <br /> HEREBY AUTHORIZE TI (CHT) <br /> op NS <br /> TO RELEASE ANY AND ALL ANALYTICALRESULTSrGEOTECHNICAL DATA AND/OR <br /> ENVIP.ONMENTAL/SITE ASSESSMENT INFORMATION TO THE SAN JOAQUIN LOCAL HEALTH <br /> DISTRICT AS SOON AS IT IS AVAILADLC AND AT THE SAME TIME IT IS PROVIDED <br /> TO ME OR MY REPRESENTATIVE. <br /> FOWNER/ <br /> NAME: 55,�' <br /> lf APP(ICAIL£J <br /> ERATOR: � . <br /> (EASE PAINOE <br /> t f/ <br /> rrrlcE� <br /> ' f516NA1tl1t£1 ` <br /> L=:?= <br /> ADDRESS: / - D. An <br /> ("ILING ADDRESS) <br /> (Clrr) (SIAL£) (ZIP) <br /> PHONE: (;W ) q <br /> DATE: <br /> EH 2O 041 Revised 1/89 <br /> Administration Clinical Sorvicos Environmental Health 461111-3400 460.3030 Public Health Nursing <br /> Nr Pollution 468-3420 460.3060 <br /> Community Snrvlcos "-- �. <br /> 460-3470 Laboratory + <br /> 460-3020 460-3468 WIC <br /> 468.3200 <br />