Laserfiche WebLink
�A t f <br />s <br />Y�ti <br />alk ; <br />BOARD OF TRUSTEES <br />Al Crow, Pres. <br />Earl Pimentei, Vice Pres. <br /><," k <br />Tommy Joyce. Secy. <br />James F. Culbertson <br />ADJohn D. Mast, M.D. <br />Vlrginla Mathews <br />Thomas Schubert, D.V.M. <br />Daphne Shaw <br />Harvey Williams, Ph.D. <br />i <br />SAIPJOAQUIN LOCAL HEALTH DIST SERVING <br />San Joaquin County <br />1601 East Hazaiton Avenue City of Manteca <br />Stockton, California 95205 City of Escalon <br />City of Lodi <br />JOGI KHANNA, M.D., M.P.II., DISTRICT HEALTH OFFICER City of Tracy <br />City of Ripon <br />ENVIRONMENTAL HEALTH DIVISION San Joaquin County <br />( 209) 468-3420 City of Stockton <br />San Joaquin County <br />AUTHOM I Z A -r I OhJ `TO Fa EL—.EASE <br />•fa't- ANALYTICAL RESULTS <br />-W GEOTECHNICAL DATA <br />-W ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br />It THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br />LOCATED AT <br />A <br />(STREET ADDRESS) (CITY) <br />HEREBY AUTHORIZE <br />(LABORATORY or CONSOLIAND <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 PROVIDED <br />TO ME OR MY REPRESENTATIVE. <br />BUSINESS NAME: do :k 6 0 c -r <br />(IF APPLICABLE) <br />OWNER/OPERATOR: <br />(PLEASE PRINT) <br />(S161*19RE) <br />ADDRESS: ep, U lcci0�� <br />(NAILING ADDRESS) <br />r <br />(TITLE) <br />t <br />vc. (C tv. Q <br />(CITY) (STATE) (ZIP) <br />PHONE: (2,0 0' / S?- <br />EH 23 041 Rev <br />. Administration <br />468-3400 <br />Ai, Pollution <br />468-3470 <br />1/89 <br />Clinical Services <br />468-3830 <br />Community Services <br />468-3820 <br />Environmental Health <br />468-3420 <br />AIDS Information 468-3820 <br />Laboratory <br />408-3460 <br />Public Health Nursing <br />468-3860 <br />WIC <br />468-3280 <br />