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SAN JOAQUIN COUNTY �p� � �I %--2 3-?, <br /> PUBLIC HEALTH SERVICES `� + <br /> ENVIRONMENTAL HEALTH DIVISION <br /> PUBLIC RECORDS RELEASE REQUEST FORM <br /> LNDIVIDUALNAME Mj2y . \eJerta.-rt PHONE Q1(2 3St -t�iv <br /> ADD RESS 1Z to. StiCo Ct+rt & .�,)`V5;, Cid. :1 l <br /> AGENCY NAME p t-G2.tz d �5 .'CLmcp PHONE NOMIe 17_9 - ZIZ2 <br /> ADDRESS C , <br /> FILE ADDRESS LEAD ENFORCEMENT DATE OF <br /> AGENCY REQUEST <br /> �3c7 U.c tW 2c4 c�cl t ,ov Y.at Wc.b,r gWyn-1 -gc�( <br /> I <br /> San Joaquin County Public Health Services Environmental Health Division files are considered public records <br /> except for certain documents identified in the Government Code and the State Water Code. <br /> Requests for public records or file reviews are subject to charges established in San Joaquin County Rules and <br /> Regulation Environmental Health Permit Fees 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 PollIcy #91-001. <br /> SIGNATURE OF REQUESTING PART�' QG�C(//plbW7n --- DATE - Iji� <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> EH 00 14 (REV 3/91) <br />