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Michael J. Infurna Jr. <br /> Senior REHS Joaquin <br /> Public Health <br /> Site Mitigation Unit IV / LOP <br /> Fifth Floor Environmental <br /> Division....."PHS-EI-11319 <br /> (209) 468-3454 304 E. Weber St. 3rd Fir. <br /> fax: (209) 468-3433 Stockton, CA., 95202 <br /> Fcaix <br /> From: MICHAEL INFURNA, REHS <br /> To: TRISH, VIRONEX <br /> Fax #: 1-510-266-0963 <br /> Pages: 3 <br /> Phone: <br /> Date: May 26, 1999 <br /> Re: WORKERS' COMP FORM <br /> ❑ Urgent ❑ For Review ❑ Please Comment <br /> • Comments: SOME CORRECTIONS NEEDED ON THE FORM <br /> YOU FAXED BACK TO ME YESTERDAY. HERE'S A NEW BLANK <br /> ONE. BE SURE TO HAVE THE C-57 LICENSE HOLDER ONLY <br /> SIGN THIS FORM AT THE TOP. ALSO ONE OF THE BOXES <br /> NEEDS TO BE CHECKED-COMPLETE AND RETURN SO I MAY <br /> ISSUE THE PERMIT FOR THE JOB TRYING TO START JUNE 1, <br /> 1999. THANK YOU. <br /> STATEMENT OF CONFIDENTIALITY: The information in this facsimile is legally pnvileged and confidential information intended <br /> only for the use of the addressee listed on this cover sheet. If the reader of this message is not the intended recipient, or the <br /> employee or agent responsible to deliver it to the intended recipient,you are hereby notified that any dissemination, distribution or <br /> copying of this telecopy is strictly prohibited. If you have received this facsimile in error,please immediately notify us by telephone <br /> at the number listed on this cover sheet and return the original message to us at the above address via United States Postal <br /> Service. We will reimburse your costs in notifying us and returning the message to us. Thank You <br />