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1 <br /> 'BOW of TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> Al Cron,Proa, San Jo"uin County <br /> ttirl f nerAN,Vice Pres. 1601 East Hazelton Avenue City or Manteca <br /> TOM"Joym sect. Stockton, California 95205 <br /> alon <br /> J100"F.Culbertson City of Eof L" <br /> city a Loa <br /> John 0.Mut M.D. JOGI KHANNA, KID, M.P.H., DISTttiCT HEALTH Of t�Rp City of Tracy <br /> �� <br /> Thorne.Schubert DMAL ENVIRONMENTAL HEALTH D I V I S I ONI. San City a Raquin unty <br /> avhrte Shaw (209) 468-3420 City of Sto <br /> cklon <br /> Htrney NUmm PhD. i <br /> San Joaquin County <br /> AUTHOR I ZAT I ON TO RE"EASE <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 9901 Woodward Road, Ripon, CA <br /> (STREET AIitESS) (till') <br /> HEREBY AUTHORIZE Cannni P Environmental . Stockton, CA 983-1340 <br /> (LIURAIOAY .r CO1SIt1411) <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: K L� I S <br /> (If ItltICJILE) <br /> OWNER/OPERATOR: (Yl I4Q G r?r 2 �'1` f� l/S S RLL o C<J /U � <br /> (ILEASE 'RUT) (TITLE) <br /> lSli ilrRE) <br /> ADDRESS: P-0 �)tTw <br /> (Illttli A1IRESS) <br /> tv� A W'T YC- CA- q5-J,3 6 <br /> (CITY) (STATE) (lit) F.. . <br /> PHONE: S ) <br /> DATE: l q q <br /> EH 23 041 Revised 1/89 <br /> AdmimAaatlon Clk*;al sitnlove Pubic Health Nursing <br /> 4W3400 Yea-um 4ea-34M 4W-3M <br /> Air PokAion Cor w n*t SerAm laboratory IMC <br /> 4"-3470 yea-atrlo �-y:ao 4U-32W <br /> AIDS koormaion 4aa-3= <br />