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� m <br />SAN JOAQUIN cOUNTy , <br />PUBLIC HEALTH SM"cv—S <br />MVIRONMENTA.L HPALTH MVISION <br />PUBLIC RECO"S kELRASE REQUEST FORM <br />INDIVIDUAL NAME S-MFog- <br />1 AM LeFR P14ONE NO <br />ADDRESS 4U;ot,v a a p L�} to h g L K Z <br />AGENCY NAME PHONE NO i e. D <br />ADDRESS 2� 27 �S Ito 51 4rya.u.+. G4 of a.( <br />ADDRESS <br />FILE ADDRESS <br />- : � - •' _ 31i n • t <br />:t_ n <br />er:�Ityr <br />toca.( <br />_ �31oiSc. <br />!,o ceLL <br />San Joaquin County public Health SeMces. Pnvlronntentgl Health blvision tiles are considered public records <br />except for certain documents Identified In the dovetntttent Code and the State Water Code. <br />Requests tot public records of file tMeH Ate subjeet to t:hatges established in Sen Joaquin County Mules and <br />Regulation Pnvitonmentai Health Permit Pees And SetWces charges. <br />Charges tot records of documents requested by subpoena duces tecunt ere subject to changes established in <br />the Evidence Code. <br />Photo copies of public documents are subject to Public Records Policy 091 -mi. <br />SIGNATURE OF REQUESTING PARTY-- DATE SIt <br />�i ' . q -- <br />SIGNATURE OF RELEASIM OFFICIAL, DATE <br />EH 00 14 (REV 3/91) <br />go � <br />