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TRUSTEES JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> San Joaquin CountyMQa+•PAM 1601 East Hazelton Avenue <br /> adpbnwdKvice Pres Cly of Manteca <br /> Te l►joyce•seey. Stockton,California 95205 City of Escalart <br /> F.Culbertson City of Lodi <br /> Q.Mast M.D. JOGI KHANNA, M.D., M.1?H.. DISTRICT HEALTH OFFICER City of Tracy <br /> VkgWa Mathews City of Ripon <br /> Thorn"Sahuf er%D.V.M, ENVIRONMENTAL HEALTH DIVISION San Joaquin County <br /> Cape Shaw (20 9) 468-3424 City of Stockton <br /> H.rrey Williams,Ph-D- San Joaquin County <br /> AUTH©F;Z I Z AT I oN TO F;ZELEr4+Sr=- <br /> ANALYTICAL RESULTS <br /> - GEOTECHNICAL DATA <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT SC <br /> (SIREEI ADDRESS) icily) � <br /> HEREBY AUTHORIZE L F <br /> p U- <br /> (EARONATORYor CORSUifAJff) <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: <br /> (IF RIPUCABiE)•.r�..r.—� <br /> OWNER PERATOP. �~ <br /> (P FRIMU ' MILE) <br /> fSIGNAI f <br /> ADDRESS: 2 L <br /> (MAILING ADDRESS) <br /> fC111') (VAiE) (11P) <br /> PHONE: <br /> DATE: CG <br /> EH 23 041 P,evised 1/89 <br /> Administration Clinical Servicos Environmental Heath i ubltc Health Nursing <br /> 468-3400 468-3830 468-9420 468-3960 <br /> Air Pollution Community Services Laboratory WIC <br /> 468-3470 468-3820 468-3460 468-3280 <br /> ` AIDS Information 468-3820 <br />