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t FROM ENURMIAT SRVS 4122 11.21. 1990 13:24 P. 12 <br /> PUBLIC HEALTH SERVICES <br /> JpGI KHANNA M.0,,M.P.H_ ,: <br /> %lih Ott'tRt <br /> P.O,Bo:2009 r (1601 Cost Hazelton Avenue) . Stockton.Cplifurnis 95201 M <br /> (209)462.)40a <br /> ENVIRONMENTAL M£ALTM DIVISION <br /> Geos) aba-�♦�a <br /> ALj-rmO MR I Z AT Z o" YO R�1�ira.A;Zs gL <br /> • ANALYTICAL RESULTS <br /> �r OECTEDHNICAL DATA <br /> ENVIRON'7ENTAU/SITE ASSESSMENT INFORMATION <br /> n' <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY ANDfOR FACILITY <br /> LDCAT6D AT R-J � (;Ji' < p k'a - -- <br /> 1STREET ADDRESS `r 1clrrj <br /> W&BY AUTHORIZE - 5P.✓ :Z.40o,�' i r-4-Y <br /> fLAPQ i4r0PY or CONSUL rANrJ <br /> TO RELEASE ANY AND ALL ANALYTICAL RESULT61 GEOTEGMNICAL QATA AND/QR <br /> ENVIRONMENTAL/BITE ASSESSMENT INFORMATION TO SAN JOAOUIN COUNTY PUBLIC <br /> H4A4TM SERVICES AS BOON AS IT 18 AVAILASLL AND AT THR SAME TIME 17 is <br /> PROVIDED Tq MC OR MY REPRESENTATIVE, <br /> BUAINEt3B NAMEz �6/e_ S^ t C-etv Dam <br /> OWNRR/OPi[RATOttz �u1�'�ti� �. L ArIL>> _�_ „ �✓� <br /> (PL CAB R1HTJ t Tl mco <br /> ,«rorrarur,'c� <br /> ADDRESS t <br /> (ci rw (S rATF) eZ rm <br /> PHONE i 'o7) <br /> T . <br /> DATE z <br /> SH e3 041 R.wlsuti 10/69 1� <br /> A at,r4lon of S10%leiavin 4+rnq Htairr Cser�ewkry <br />