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SAN JOAQUIN COUNTY L <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT -�' t • - PHONE NO e (,'i _ ( 1\ \ <br /> ADDRESS a 3 1 1\1�4i ll ►-1 I,Uk , �'rllr KTl� l <br /> AGENCY NAME �c F= HONE NO <br /> ADDRESS �,^•yam �; <br /> FULL ADDRESS BUSINESS NAME PROGRAM OR <br /> f• FACILITY TYPE OF FILE <br /> � J () r 'it t << [ \-l:l� f1•it. ""it`.' �� 1J L'�it.f YL <br /> usT <br /> THIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC 11EAi TH <br /> SERVICES/ENVIRONMENTAL HEALTH DIVISION (FHD) POLICY #94-007, ORDINANCF- ( ODE OF <br /> SAN JOAQUIN COUNTY, END FEE AND SERVICE CHARGE RESOLUTIONS, STA:)F WA; ER CODE, <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. <br /> 1. A MAXIMUM OF TEN L02 PREMISE ADDRESSES PER REQUEST <br /> 2. PUBLIC FILESRECORDS REVIEW IS BY APPOINTMENT ONLY. APPOINTMFbITS AF:F' F•RC)CESS- <br /> ED BY CALLING (209)468-3420. OFFICE HOURS FOR APPOINTMENTS ARF SCI IF 11'It r I - I:40NDA.Y <br /> THRU FRIDAY EXCLUDING HOLIDAYS, 8:00 AM TO 12:00 NOON AND 1:0010 4:au F'M. <br /> 3. A PUBLIC FILES/RECORDS RELEASE APPLICATION' (PRRA) IS REQUIRED. <br /> 4. PUBLIC FILESiRECORDS NOT RETURNED IN THE SAME CONDITION AS Rl ( 1 I':rI "'III RE <br /> CORRECTED BY THE EHD STAFF AT THE EXPENSE OF THE APPLICANT. THIS /V,(d: !'?IIAL <br /> SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. (SEE EHD POLICY 94- 007) <br /> 5. ORIGINAL PUBLIC FILESMECORDS SHALL NOT BE REMOVED FROM THE FI-1D PREMISES. <br /> ............ ............. .............,r................., .., .,. . ......... <br /> SIGNATURE OF APPLICANT ( '� <br /> DATE <br /> — <br /> SIGNATURE OF RELEASING OFFICIAL l�o� DATE <br /> EH 00 14 (REV 9/96) <br />