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SAN JOAQUIN COUN'T'Y <br />PUBLIC HEALTH SERVICES II <br />ENVIRONMENTAL HEALTH DIVISION u 3 ~ <br />PUBLIC RECORDS RELEASE REQUEST FORM <br />INDIVIDUAL NAME-T�,, rnaS -T\/Gk IC�n PHONE NO I <br />ADDRESS 1 R -te t_f , (:�R <br />AGENCY NAME Co PHONE O 9a.wrn2, <br />ADDRESS <br />rP <br />FILE ADDRESS LEAD ENFORCEMENT D TE OF <br />AGENCY REOUEST <br />> <br />-9 <br />MUMMOV <br />•,► <br />FM rr <br />M <br />FM <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 Pofiry #91-001. <br />SIGNATURE OF REQUESTING PARTY DATE Z 9S <br />SIGNATURE OF RELEASING OFFICIAL <br />EH 00 14 (REV 3191) <br />DATE <br />