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J <br /> BOARD of TRUSTEES �►N JOAOUIN LOCAL HEALTH DI 'i RICT SERVING <br /> Al Crow,Pres. <br /> Earl Pimentel,Vice Pres. 1601 East Hazelton Avenue San Joaquin County <br /> Clay of Manteca <br /> Tommy Joyce,Secy. Stockton, California 95205 City of Escalon <br /> James F.Culbertson City of Lodi <br /> John D.Mast,M.D. JOG[ KHANNA, M.D., M.P.i1., DISTRICT HEALTH OFFICER City of Tracy <br /> Virginia Mathews City of Ripon <br /> Thomas Schubert.D.V.M. ENVIRONMENTAL HEALTH DIVISION San Joaquin County <br /> Daphne Shaw (209) 4GS-3420 City of Stockton <br /> Harvey Williams,Ph.D. San Joaquin County <br /> A U T H O R I Z A T I O N T C3 FR E L—E A E3 E <br /> - <br /> ANALYTICAL RESULTS <br /> - GEOTECHNICAL DATA = - <br /> - ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I , THE UNDERSIGNED OWNER AND/OR OPERATOR,' OF THE PROPERTY AND/OP, FACILITY <br /> LOCATED AT 48 N. Wilson Way Stockton, CA <br /> (S1RERESS) lC1IY1 <br /> HEREBY AUTHORIZE_ F. Weston, Inc. <br /> (LA10RAT0RY or CONSULTANT) <br /> TO RELEASE ANY AND ALL ANALYTICAL RESULTS, GEOTECHNICAL DATA AND/OR <br /> ENVIP.ONMENTAL/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 APPLICABLE) <br /> OWNER/OPERATOR: Raymond Rishwain, DDS -- owner <br /> (WjSE PRINT) a (TITLE) <br /> Q A), <br /> 1S16N URE) <br /> ADDRESS- 1031 N. Eldorado <br /> (#AILING ADDRESS) <br /> Stockton, CA 95202 <br /> (CITY) (STATE) (ZIP) <br /> PHONE: ( 209 ) 466-0478 <br /> DATE: <br /> EH 23 041 Revised 1/89 <br /> Administration Clinical Services Environmental Health Public Health Nursing <br /> 468-3400 468-3830 468-3420 468.3860 <br /> Air Pollution Community Services Laborotory WIC <br /> 460-3470 468-3820 408-3460 468.3200 <br /> AIDS Information 468-3820 <br />