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i—ARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> 0 Crow,Prra San Ioayuln County <br /> Earl Pimenrsl,Vlca Pres, 1501 East Hazelton Avenue City of Manteca <br /> T.ommyJane,Sec•y. Stncktan,CaRfornis 95205 City of Escalon <br /> Free F.Culborwri City of Lodi <br /> to D,MoaS M.D. JOGI KHANNA:M.D., M P.II.r DISTRICT HEALTH OFFICER City of Tracy <br /> VIFT, lathe*# City of Aipon <br /> T,�Schubert,D.V.M. ENVIRONMENTAL HEALTH DIVISION San Joaquin County <br /> r, ;hna Show (209) 468-3420 City of Stockton <br /> F ,%VY Wifllnms.Ph.D, San Joaquln.County <br /> �V"�"': ice^ i Z^-r t C]RV i O �LEABI= <br /> -f"e- ANALYTICAL RESULTS <br /> f� GEOTECHNICAL DATA <br /> i <br /> * ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> r THE UNDERSIGNED OWNER AND/OR OPERATOR QF THE PROPERTY AND/OR FACILITY <br /> f-]GATED AT rbc) m- WttseY\. I,LJPr.A <br /> (SCREE( APDRESSI (City) <br /> HEREBY AUTHORI"r <br /> (tABORAFOAr or CORSILIARF) <br /> wI RELEASE ANY AND ALL ANALYTICAL, RESULTS, GEOTECHNICAL DATA AND/OR <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION TO THE SAN JOAQUIN LOCAL HEALTH <br /> 64STRICT AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED <br /> _� -.•S OR MY REPRESENTATIVE. <br /> F?JSINESS NAME: (�U o l <br /> (If ArPuGABL0 <br /> OWNER/OPERATOR: <br /> Z vLr ' m r�5 Al <br /> (P( �RiJfFJ (IdtlE) <br /> 8A RE) <br /> ADDPESS: 1100 111- W ��o,tit F.17 fit , <br /> (RAILING ADORES$) <br /> (City) ($IAIEJ flit) <br /> _ PHONE: QL')9 ���- 5 0 <br /> DATE: <br /> -• ._.----------E-L-23-041�Revised--I/f39----- --- ------ ------- ----- - -------- ---- ----- <br /> Admintatration Clinical Servicos Environmental Health Public Hoalih Nursing <br /> 466.3400 468.3830 468-3420 465.3080 <br /> Air Pollution .Community Sorvlces Laboramry, WC <br /> 466-3170 466-3820 46a-3400 408-3203 <br /> AIDS Information 458-3920 <br />