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Ti' 149 c£3`'3 P.02 <br /> y <br /> Ell 00 14 (IMV 5/94) SAN JOAQUIN COUM Y <br /> PUBLIC IIT..ALITI SERVICES <br /> ENNVMONJ14EN'rAL HEALTH DMS10N <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT�keQ, G �tn, MONS NO 040,) - <br /> ADDRESSCi,j�c.CQf4gz Ta <br /> AGENCY NAt4E �� 'PHONE NO <br /> ADDRESS <br /> r SLE ADDRESS 1 G [^ LEAD <br /> AGENCYc L (f DATE <br /> ac <br /> � <br /> ra 1�ScL_S1-lS <br /> 1•Ii1S 11d0110E IS SUBJECT TO THE REQUIRFIr1ENTS 1DEN11FIFD IN TTIE PUBLIC HEALTH <br /> SfSRVIC-OIENVIROUhiENTALHEALT14 DIVISION (EHD)POLICY#94-007, ORDINANCE..CODE OF SAN <br /> JOAQUIN COUNTY. EHD FP.E-S AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE, <br /> GOvERNMENT CODE AND 'I714E EVIDENCE CODE. <br /> [. A MAXIMUM OF TEN (10)MEMISE ADDRESSES PER REQUEST. <br /> 2 IIURLIC FiLFS!RL-CORDS REVIEH'Is BY APPOINTMENT ONLY. APeonrrniENrs ARE ARRANGED RY <br /> CALLING (209)46$-0?40. OFFr-E HOURS FOR APPOINTM E11U9 ARE SCHEDULED MONDAY THRU FRIDAY <br /> EXCLUDING HOLIDAYS, 5:00 AM TO 1.2.:00 NOON AND 1:46 FM TD 4:34 pm- <br /> 3. A PUBLIC RECORDS RELEASE APPLICATION (IIRRA) IS REQUSRED, <br /> 4. PIJUC FILE-S!RECORDS NDT RETURNED IN THE JAMS CONDITION AS RECEIVED WILL BE CORRECTED <br /> BY TILE FFD STAFF A7 THE EXPENSE OF THE APPLICANT. TTHi$ ADDITIONAL SERVICE WILL RE BILLED TO THE <br /> ,PPLICANT FOR PAYMENT. (SEE EHD Poucy 94.007) <br /> J. ORIGINAL PUBLIC I-ILES/RE DL L NQr 6 9ov1yD.mom TNB EIID PREMUEs. <br /> SIGNATURE OF APPLICANT / DAA ^ �� <br /> SMNATLIRE OF REI-EASIN00TFiCIAL DATE <br /> ivO PHS-'EHO RECORDS/FCLFS ARE IDENTIFIED: <br /> PHSfEHD RFL'ORDsyFILEs EXIST ON THE ADORE=(ES) NOTeD, YOU WILL OF NOTIFIED WHEN <br /> RECORDS/PILES ARE AVAILABLE FOR RENEW: - <br /> Ih,e: Fm".wvo..: (binu�kn h.nm <br />