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�5 <br /> San J.oaq'uin County <br /> tal Health Department <br /> 304 E Weber Avenue FAX #: ❑✓ (209) 4640'f 38 <br /> 3rd Floor, Stockton, CA 95202 <br /> Phone: (209) 468-3420 <br /> . ❑ (209) 468-8392 <br /> (209) 468-3433 <br /> F� Date: Time: <br /> # of Pages (including this sheet): <br /> To: FAX ( i <br /> I t3 <br /> Of: <br /> From: Voice Phone #: <br /> Re: <br /> ci <br /> ❑ Urgent For Review ❑ Please Reply [] Please Recycle <br /> Comments: <br /> STATEMENT OF GONFIDCNTIALITY: The information in This facsimile is legally privilagCd and confidential info+ aii into od ty for Iho us of tho addrossee <br /> listed on%his cover sheet. U the roadcr of this message is not the intended recipient,or the employee or agent responsilk to cr it to Iho intended rocipiortl, <br /> you are hereby notified that any dissemination,distribution or copying of this tClecopy is strictly prohibited. I{you haat received this facs;m;�in error,pteaso <br /> immedialCly n04fy us by lefenhone al the number fisted On this cover sheet and return the original mosSaga to us at the above addfass wa United Stales Postal <br /> Service. We w it reunburse your costs in notifying us and returning the massage to us. Thank You. <br /> EHb 413-01-012 <br /> REVISED 6-14-02 FAX COVER SHEET <br />