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BOARD OF TRUSTEES iN JOAQUIN LOCAL HEALTHG_ ,'FUCT <br /> AI Crow,Pr", SERVING <br /> Tommy Joys@,S�'y. <br /> Earl Pim�ntgl,Vic@ Pres 1601 East Hazelton Avenue <br /> San Jo7quin County <br /> jam"F,Cul"rtaon Stockton. California 95205 City of Manteca <br /> John O.MAst M.D. City of Fsralnn <br /> JOGt 1SHANNA, M.D., M.P.H., DISTRICT "CALTH OFriCt:p City of Lodi <br /> `llrginfA Mathews <br /> Thomne schubort O.V.M. ENVIRONMENTAL HEALTH DIV.I S I ON CitY of Tracy <br /> Daphne Shaw City of Mpon <br /> Harv"Willigms,Ph,D, t 209) 458--24A'�q San Joaquin County <br /> City of Stockton <br /> A L1 T M C7 RI Z T I C)RJ San Jagquin County <br /> -t*- ANALYTICAL RESULTS <br /> - - GEOTECHNICAL DATA <br /> E - ENVII:ONMENTAL/SITE ASSESSMENT INFORMATION <br /> r , THE UtVpFTsa I hil=D OWNER AND/OR OPERA FOP OF 'EHE PPOPEPTY AND/OP FAC I I_I TY <br /> LOCATED AT 21 q -'�', PAPA(( E(. <br /> (STREET ADDRESS) _ (C1iT1 <br /> HEFEEtY AUTHOF?IZE�()A-L.-12LO� <br /> TO PELEASE ANY AND ALL ANALYTICAL R'ESLIL T Sr GEOTECHNICAL DATA AND/OR <br /> ENVIPUNMENTAt_/SITE ASSESSMENT INFOPMATION TO THE SAN JOAQUIN LOCAL HEALTH <br /> DISTRICT AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT I5 PROVIDED <br /> TO ME OR MY PEPRE,S,ENTATIVE. <br /> BUSYNESS NAME: 4 <br /> (IF ArPCICAB(E) <br /> OWNEP,/QPEPATUP.: c t 'e(' C `e <br /> (P(EASE PRINT) <br /> (SIGNRTURf) <br /> A D DRE S; <br /> —C-22. <br /> PHONE: <br /> (1!AltIJr6 ADDRESS) <br /> PHONE: <br /> DATE: <br /> EH 23 041 Revised 1189 <br /> Administration Clinical Services <br /> 480-3400 Environmental Hegith Pubf1c Health Nursing <br /> 469-3810 468-3420 <br /> Aiv Pollution4 -3850 <br /> 488-3470 Community Services Laboratory — <br /> 468-382p 458-5460 b'nC <br /> 458-:t2a0 <br /> AIDS informst{on 4en.1". <br /> ---- r, T l ?i?UYI:�OiUt1 'S:b T 06, GT ,�jdFl <br />