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PUBLIC HEALTH SERVICES <br /> SAN JOAQUIN COUNTY a o <br /> ENVIRONMENTAL HEALTH DIVISION <br /> Ernest M. Fujimoto, M.D., M.P.H., Acting Health Officer , <br /> 445 N. San Joaquin Street 0 P.O. Box 388 • Stockton, CA 95201-0388 <br /> (209) 468-3420 <br /> N M7MG PARTICIPATION RECORD <br /> r'"N <br /> SUBJECT: V,D�A,T,DYt S oCAy 5T '`��Ia�t onS aT ZOS/ 1Jb,5 'I <br /> DATE & T1M[E: Ari% 21 /99z/ a� 9!0z)Am <br /> LOCATION: 2ablib A4A 4VA y& 2S --�,-17V1/"M"Q 1Jr�U/SlOh <br /> NAME REPRESNE NO. <br /> 17 <br /> .2 <br /> 3. <br /> 4. �l �%dee �aods <br /> Ir <br /> 5. _ <br /> 7. <br /> 8. <br /> 9. <br /> 10. <br /> EH 23 056 (revised 8/11/93) <br /> A Division of San Joaquin County Health Care Services <br />