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1 VJ <br /> SAN 7OAQUIN COUNTY <br /> • P"LIC ELEALTs SERVICES ' • /r tecJ #� q5 L8 <br /> ONI►1fIML URAL'TIi DM' <br /> PiUBLIC RECORDS RR7.1J.,tSE REQUEST FORM <br /> INDIVIDUAI;NAKE JEFFREY B. SETNESS PHONENO 916-99 +0 <br /> ADDRESS 3203 -��t trL Stockton CA 95219 <br /> AGENCY NAME PRONE NO <br /> A )DRESS i <br /> i <br /> FILi3 ADDEii LEAD- FOR &EL41- AATE bF <br /> AGENCY REOUEST <br /> USA GASOL!I. STATION N0. 110 ,L�c� �� d� Mar 30 , 1995 <br /> •j / 2132 Mari�)osa .Road <br /> StolcT<ton,j aj omnia <br /> i <br /> 1 <br /> i <br /> i <br /> i <br /> 1 <br /> i . <br /> i <br /> Salm,70"Qmn Pablic Heahh Sccvkea Eavitvnm=W Health Division Bks are colmddered public records <br /> except for certtiftldoc=2cpft k cautiied in tare Cnvr:amcal Code and the State Water Code. <br /> FteQaests for PaW�c records Or file reviews aro mbject m ckzi6 establit e ar San Jc,g County Risks and <br /> R.erudon Eumanlnental Hearth Petmd F-xs ow ser.ices Clurgct <br /> Cbuges for teca 6 or daca tr=ts requested by sabpoeaa daces sentm arc sabjea to clta:tges estabinthed is <br /> the Evidence Code <br /> PlfotO=Pks of P° d Qoeamentt are subject to Pabik Reustrts porky #93ML <br /> SIGNATURE OF REQUESTING PARTY � DATE j f <br /> SIGNATURE OF RELEASING OFFI DATE <br /> EH 00 14 (REV 3/91) <br /> Y07AL P_32 <br /> hec'� <br /> TOTPL P.93 <br />