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SAN JOAQUIN COUNTY <br /> PUBLIC HEAL'T'H SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> PUBLIC RECORDS RELEASE REQUEST ,FORM <br /> IND IVID UAL NAIvLE eoV /"1) 6IZZ4 ZAAJI 4� P HONE NO(a�� X40 z0 06-�, <br /> ADDRESS Z)6 � l��cT7� G�-vv�� g3�! <br /> AGENCY NAME PHONE NO <br /> ADDRESS <br /> FILE ADDRESS LEAD ENFORCEIMENi' DATE OF <br /> AGENCY REQUEST <br /> l l 'JAV 2 sTZx KTP <br /> (rt ?-4C ti�AV V be, _ 5TH TwJ <br /> Zc7 Si rte{1 Pu A V' l m 4T01i <br /> d ZJ �N <br /> C4AIZTM, WAY 5TCC4C--TZi1J <br /> PqZTL-W-CL <br /> 145 �• L��c...ot.� �'� - s�cccfir.l <br /> C 1 o a iv <br /> s77 rC-Kz,J <br /> San Joaquin County Public Health Services Environmental Health Division ales are considered public records <br /> except for certain documents identil5ed in the Government Code and the State Water Code. <br /> Requests for public records or ale reviews are subject to charges established in San Joaquin County Rules and <br /> Regulation Environmental Health Permit Fern and Services Charges. <br /> Charges for records or documents requested by subpoena duces tecum are subject to changes established in <br /> the Evidence Code. <br /> Photo copies of public documents are subject to Public Records Policy #91-001- <br /> SIGNATURE OF REQUESTING PAR DATE <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> EH 00 14 (REV 3/91) <br />