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-34- ANALYTICAL RESULTS <br />-x- GEOTECHNICAL DATA <br />-be- ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br />I, THE UNDERSIGNED OWNER AND/OF. OPERATOR OF THE PROPERTY AND/OF FACILITY <br />LOCATED AT 601 E. Ljemw LI -A LOP j <br />(STREET ADDRESS) ' (CITY) <br />HEREBY AUTHORIZE <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 PROVIDED <br />TO ME OR MY REPRESENTATIVE. <br />BUSINESS NAME: 17-0t2,i�-F-T Q�SSUG P�Lat�NTs �Op UN�GAIs� <br />(IF APPLICABLE) <br />I <br />OWNER/OPERATOR: •JOHN tC �S <br />(PLEASE PVNI) (TITLE) <br />c�" (SISNATU � <br />ADDRESS: /Oo <br />(NAILING ADDRESS) — -- <br />L.��-�PU�. <br />(CITI) (STATE) (ZIP) <br />PHONE: (415) ¢6,1 I <br />DATE: <br />EH 23 041 Revised 1/89 <br />Administration Clinical Services Environmental Health <br />468-3400 468-3830 468-3420 <br />Air Pollution Community Services Laboratory <br />468-3470 468-3820 468-3460 <br />AIDS Information 468-3820 <br />Public Health Nursing <br />469-3860 <br />WIC <br />468-3280 <br />BOARD OF TRUSTEES <br />SAN JOAQUIN LOCAL HEALTH <br />DISTRICT <br />SERVING <br />Al Crow. Pres. <br />"Earl Pimentel. Vice Pres. <br />1601 East Hazelton Avenue <br />San Joaquin County <br />Tommy Joyce, Secy. <br />Stockton, California 95205 <br />City of Manteca <br />City of Escalon <br />James F. Culbertson <br />City of Lodi <br />John D. Mast, M.D. <br />JOGI KHANNA, M.D., M.P.H., DISTRICT HEALTH OFFICER <br />City of Tracy <br />Virginia Mathews <br />City of Ripon <br />Thomas Schubert O.V.M. <br />ENVIRONMENTAL HEALTH DIVISION <br />San Joaquin County <br />Daphne Shaw <br />Harvey Williams, Ph.D. <br />(20 9) 468-3420 <br />City of Stockton <br />San Joaquin County <br />AUTHClFi I ZAT I OhJ TO <br />RELEASE <br />-34- ANALYTICAL RESULTS <br />-x- GEOTECHNICAL DATA <br />-be- ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br />I, THE UNDERSIGNED OWNER AND/OF. OPERATOR OF THE PROPERTY AND/OF FACILITY <br />LOCATED AT 601 E. Ljemw LI -A LOP j <br />(STREET ADDRESS) ' (CITY) <br />HEREBY AUTHORIZE <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 PROVIDED <br />TO ME OR MY REPRESENTATIVE. <br />BUSINESS NAME: 17-0t2,i�-F-T Q�SSUG P�Lat�NTs �Op UN�GAIs� <br />(IF APPLICABLE) <br />I <br />OWNER/OPERATOR: •JOHN tC �S <br />(PLEASE PVNI) (TITLE) <br />c�" (SISNATU � <br />ADDRESS: /Oo <br />(NAILING ADDRESS) — -- <br />L.��-�PU�. <br />(CITI) (STATE) (ZIP) <br />PHONE: (415) ¢6,1 I <br />DATE: <br />EH 23 041 Revised 1/89 <br />Administration Clinical Services Environmental Health <br />468-3400 468-3830 468-3420 <br />Air Pollution Community Services Laboratory <br />468-3470 468-3820 468-3460 <br />AIDS Information 468-3820 <br />Public Health Nursing <br />469-3860 <br />WIC <br />468-3280 <br />