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4 • F+ UG - 3 1 - 92 r90N 1 !5 45 P 92 <br /> PUBLIC . ft"LTH 61MVICNS <br /> 1 EN`VIRONA4tNI'AL 11312"'I',8 Dty>isloN <br /> LtBLIC RECO"s .RELFA E R>t�t�tI4Ot FORM <br /> INDIVIDUA.LfI �1J • E . � . 7Fr Hf k= Ay ('�p. p PHONE NOI /'a14) r, 3 tt33 <br /> ADDMS . a �` eA 5 <br /> AGENCY NAME PHONE NO <br /> ADDRESS <br /> FILE ADDRESS LEAD ENFQRCEM1yN I' DATE DE <br /> AOEN4"Y EAQUEST <br /> an zs P B /3I ASAP <br /> +k <br /> dt c k n) <br /> t] awt . <br /> wky <br /> +k fko�t, <br /> pr; WkI sll�+ Gr t" e a <br /> $an Iosquln County Pu Ile Hetlth services Environmental Health Dlvislau thea ore considered public records <br /> except for certain docu cuu ldeolWd In the covommoll Code Ind the state Water Code. <br /> Requests tot public re rdt or Alt fevie" Are iub)ect to charges established In Sen Jooquin County Rules and <br /> Regulation Eevironme tat Health Permlt Fees And semod Charges$ <br /> charges fat records of jocurnentf requested by subpoena duces locum Ire subject to change3 established In <br /> the Evidence Code. <br /> Photo copies of public lowntabit ore lubject to Public Records Policy #9i*Mi, <br /> SIONATUREOI{ EQUFSTIMPAR7 Y� R DATr? st 9z <br /> SIGNATURE C7P ELFASIN4 OFFICIAL DATE , <br /> 914 00 14 (REV J ) <br /> �J t <br /> It <br /> t ' d tb : st as . tS � eo � woa � <br /> i <br />