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SAMAQUIN <br />—COU NTY— <br />Creat nest grnos h�:e. <br />Environmental Health Department <br />Site Location: ( G, SR# or WP#: <br />city: Date: <br />0 <br />ose, <br />1868 E. Hazelton Avenue ( Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />1 <br />OL <br />