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BOARD OF TRUSTEES OAN JOAQUIN LOCAL HEALTH &TRICT SERVING <br /> At Crow,Pres. San Joaquin County <br /> Earl Pimentel,Vice Pres. 1601 East Hazelton Avenue City 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. JOGI KHANNA, M.D., M.P.H., 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) 468-3420 City of Stockton <br /> Harvey Williams,Ph.D. San Joaquin County <br /> AIJTHOF;Z I ZAT I ON TO FZE_LEASE <br /> -x- ANALYTICAL RESULTS <br /> -K- GEOTECHNICAL DATA <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I , THE UNDERSIGNED OWNER, AND/OR. OPERATOR OF THE PROPERTY AND/OR, FACILITY <br /> LOCATED AT 102 South Wilson Way Stockton <br /> (STREET ADDRESS) (CITY) <br /> HEREBY AUTHORIZE Superior Analytical Laboratory Inc. <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: Roek Brothers <br /> (IF APPLICABLE) <br /> OWNER,/OPERATOR: Don Roek <br /> (PLEASE PRINT) (TITLE) <br /> Qr �(�H_O1�YLlwa <br /> (SIGNATURE) (() <br /> ADDRESS: 102 South Wilson Way <br /> (NAILING ADDRESS) <br /> Stockton. CA 95213 <br /> (CITY) (STATE) (ZIP) <br /> PHONE: ( 209 ) 464-8344 <br /> DATEk, Pt'L4, <br /> EH 23 041 Revised 1/89 <br /> Administration Clinical Services Envlronmental Health Public Health Nursing <br /> 468-3400 468-3830 468.3420 468-3860 <br /> Air Pollution Community Services Laboratory NIC <br /> 468-3470 468-3820 468-3460 468-3280 <br /> AIDS Information 468-3820 <br />